One of the first questions my patients ask about persistent or lingering back pain is, "Is my condition serious?" I use 4 questions to assess if lingering back pain is unlikely to resolve on its own orcould be arising from a serious underlying medical condition.
Before You Continue
Keep in mind that back pain is incredibly common and normally goes away on its own. Here are a few key points:
If you have worrisome or "red flag" symptoms, you could be part of the 1% of the population with a severe underlying medical condition, such as metastatic cancer of the bone, bone infection (osteomyelitis), or severe pinching of a nerve root (radiculopathy). If you have any of the following symptoms, you should seek medical evaluation as soon as possible.
Red Flag Symptoms
Back pain that has been present for less than 4 weeks is considered "acute" back pain. Acute back pain is highly likely to resolve on its own without medical treatment. Patients with acute back pain usually do not require medical attention unless their back pain is highly debilitating, i.e, severely limiting your ability to perform daily tasks.
Just remember, severe pain (especially if it comes on quickly) is usually a warning sign from your body that something may be seriously damaged. If the pain is so severe that you can't do normal daily activities like walk, get out of the car, or transition from standing to lying, then seek medical help.
Severe debilitating pain, especially if bedridden, can lead to serious downstream medical problems such as blood clots, deep vein thrombosis, lung collapse, atelectasis, and pneumonia. Sometimes severe pain, especially when it comes on quickly, can be related to a spinal compression fracture or insufficiency fracture.
Nearly 50% of acute back pain resolves within 2 weeks and 80% resolves within 3 weeks.(2)
If your back pain has lasted longer than 4 weeks, it could be time to see a specialist. Back pain lasting between 4-12 weeks is defined as "subacute" and back pain that has lasted longer than 12 weeks is considered "chronic."
Generally speaking, the body should be able to heal itself within a 4-12 week period. If pain persists beyond the 4-week mark, evaluation by a physician is warranted to understand why your body is still sending pain signals to the brain. The longer your back pain lasts, the less likely it will resolve on its own.
If you have had back pain for longer than 6 weeks and you are struggling to perform your daily tasks, consultation with a pain doctor or a free consult with a coordinator is recommended.
If your back pain is becoming worse over time or severely limiting your daily activities, you should strongly consider scheduling a consultation with an expert regardless of how long the pain has been present.
The natural course of back pain should be steady improvement over time. Worsening pain indicates that the underlying cause of pain is not resolving in the usual manner.
Ask yourself the following questions:
If you answered yes to either question, consider a consultation with a medical specialist.
If you've tried over-the-counter medications, physical therapy, or other conservative therapies for over 6 weeks and you're still in significant pain, it's most likely time to be evaluated by a specialist.
Minimally invasive procedures such as steroid injections and nerve ablation can help patients achieve pain relief and avoid invasive surgical procedures.