Back pain emergency ยท ER symptoms
For the back or neck pain on this page, do not drive across the river to us. Go to the nearest emergency department.
Back or neck pain is an emergency when it comes with new bladder or bowel trouble, saddle numbness, spreading weakness, fever, a fall or crash, or tearing pain in the belly or back. Those belong in the nearest emergency department today, not at a pain appointment over the bridge. This page explains why each one is on the list.
Why a pain clinic keeps a page that sends you somewhere else
A pain practice sees the same spines an emergency department sees, only weeks later, after whatever mattered has already shown itself. From Highland this office is close to an hour away with no traffic; from Belleville about forty minutes. A bundle of nerve roots being crushed at the bottom of the spinal canal is measured in hours, not appointment slots. A low back that has ached for two years can still hide a bleed, an abscess, an unstable fracture or an artery, and nothing on this site fixes any of those. So the list below is short and blunt. Each item carries the reason it is there. If you see yourself in one of them, stop reading and go.
What are the red flags that make back pain an emergency?
BLADDER, BOWEL, SADDLE
New trouble starting your stream or emptying fully, leaking you cannot feel, loss of bowel control, and numbness across the parts of you that would touch a saddle. Sexual numbness counts. This is the cauda equina, the bundle of nerve roots below the end of the spinal cord, being squeezed. Most often a large central disc herniation is the cause. Whether bladder function comes back depends on how fast the pressure is taken off. The surgical and legal writing on this condition is a catalog of delays that started with someone deciding to wait until morning.
WEAKNESS THAT IS SPREADING
A foot that slaps the floor, a knee that buckles on the stairs, a hand that drops the coffee cup, and any of it getting worse over hours or days rather than better. Pain in a nerve is one thing. A nerve losing its power to move a muscle is another. The second one is a surgical conversation with a clock on it. Strength that is lost while everyone waits for a scan appointment does not reliably come back.
FEVER WITH SPINE PAIN
Back or neck pain with a temperature, chills or drenching sweats, especially in anyone with diabetes, on dialysis, on immune-suppressing medication, injecting drugs, or within weeks of a spine procedure or a bloodstream infection. Infection can seed the space around the spinal cord. The textbook triad of fever, spine pain and neurological loss is complete in only a minority of the patients in whom it is finally found. Fever plus spine pain is enough on its own. Blood cultures and an MRI with contrast are emergency-department tests, not pain-clinic tests.
THE FALL, THE CRASH, THE BONE
New spine pain after a fall, a crash on I-64, or even a hard cough or a lift in someone over 65, on long-term steroid medication, or with known thin bone. A systematic review pooled primary-care low back pain patients. The findings that best predicted a fracture were older age, long-term corticosteroid use, a significant mechanism of injury and a bruise or scrape at the painful spot. A fracture that is unstable needs to be known about before anyone bends you. That means a same-day image.
A CANCER HISTORY, OR WEIGHT YOU DID NOT TRY TO LOSE
A past cancer is the single finding with the most consistent evidence for spinal cancer among the low back pain patients studied. Pain that wakes you at night and does not change with position, or weight coming off without a diet, adds to it. This one is not always a same-day emergency. But it is a same-week imaging study, ordered by whoever can get it fastest. If there is any weakness or numbness with it, it becomes today.
TEARING PAIN IN THE BELLY OR BACK, OR PRESSURE IN THE CHEST
Sudden, severe pain in the abdomen, flank or low back that feels like something ripping, with faintness or a racing pulse, in a man over 60 with a smoking history or high blood pressure, is an aortic aneurysm until an emergency department proves otherwise. In a multicenter emergency-department cohort of 85 ruptured aneurysms, about one in four was misdiagnosed on the first clinical assessment. Most of them had walked in complaining of abdominal or back pain. Chest pressure with pain into the arm or jaw, sweating or breathlessness is the heart, not a cervical disc. Call 911 for either. Do not drive yourself, and do not drive to us.
THE WORST HEADACHE OF YOUR LIFE, OR NEW SYMPTOMS AFTER A SPINE INJECTION
A headache that reaches full force within a minute is a 911 call whatever else is going on. Separately, watch the hours to days after any spine injection, anywhere. New leg weakness, numbness that is spreading, new bladder trouble or severe back pain out of keeping with the procedure can mean bleeding around the spinal cord. The risk is highest in patients on blood thinners. That is the entire reason the regional anesthesia societies publish rules about when those drugs must be paused before a needle. It is also the reason we ask about every one of them, including the aspirin, before yours. A headache after an epidural that is bad standing and eases lying flat is a different problem, a leak of spinal fluid. That one is a same-day call to us rather than an emergency department.
What should I do if my back pain is an emergency?
- Call 911 or have someone drive you to the nearest emergency department on your side of the river. Nearest wins; the bridge does not.
- Take the medication list, including any blood thinner and any opioid. Bring the date of your last spine procedure if you have had one.
- Tell them what you are worried about in the words on this page. “I cannot feel myself urinating” gets a different triage than “my back hurts.”
- Let us know afterward. If you are admitted at Anderson Hospital in Maryville, Dr. Gurpreet Singh Padda, MD, MBA, MHP is on staff there and the treating team can reach him; anywhere else, we will coordinate your follow-up once you are home.
When is back pain not an emergency?
A flare of the pain you already know, even a savage one. Leg pain in the same pattern you have had for months. Soreness for two days after a block, which is the needle track and the joint objecting, not a complication. Numbness in the same patch it has always been in. Those are urgent calls or texts to this office. They are the reason the number is on every page. But they are not reasons to sit in an emergency department for six hours at 2 a.m. and be sent home with a scan you already had. That line is the whole point of this page: new function lost is an emergency; old pain turned up is a phone call. If you cannot tell which it is, call us during hours, and outside hours lean toward the emergency department.
Common questions
Is sciatica an emergency?
Pain running down the leg in a pattern you can trace is a diagnosis waiting for a visit, not an emergency. sciatica explains the four things that produce it. A leg that will no longer lift the foot, or a bladder that has stopped behaving, is the emergency.
Should I text the office before I go to the emergency department?
Call 911 or go first, and tell us afterward. The text line at contact is read during office hours by a person, not by an algorithm at midnight. The conditions on this page do not wait for morning.
How quickly does cauda equina need surgery?
Sooner is better at every time point that has been studied. The reviews of this condition argue for decompression as soon as it can safely be done, rather than waiting for a deadline. The disc that causes it is usually a large central one, described in herniated disc.
Is pain after a fall always a fracture?
Most falls bruise and do not break. But in an older spine, or one thinned by steroids or metabolic disease, a fracture can follow a fall that would not have broken anything twenty years earlier. The image settles it. If it is a fracture, compression fracture covers what happens next.
What if it happens the night after an injection here?
New weakness, spreading numbness or bladder trouble after a spine injection is an emergency department visit whoever did the injection, and you will have been told that before you left. Ordinary soreness and the numb leg that wears off by evening are described in driving home after a spine injection.
How do I know if my back pain is serious?
The dividing line is function, not how much it hurts. New function lost is an emergency: a foot that slaps the floor, a bladder that has stopped behaving, numbness that is spreading. Old pain turned up, even a savage flare in the same place and pattern you know, is a phone call to this office. If you cannot tell which it is, call during hours, and outside hours lean toward the emergency department.
What are three red flags of back pain?
Three that send you to the emergency department today: new bladder or bowel trouble with numbness in the saddle area, weakness that is spreading over hours or days, and fever with spine pain. Others on this page count too, including new pain after a fall or crash, and tearing pain in the belly or back with faintness or a racing pulse.
Should I go to the nearest emergency room or one near the pain clinic?
The nearest one, on your side of the river. Nearest wins; the bridge does not. Call 911 for tearing belly or back pain or chest pressure, and do not drive yourself. Take your medication list and the date of any recent spine procedure. If you are admitted at Anderson Hospital in Maryville, Dr. Padda is on staff there and the treating team can reach him.
Is a headache after an epidural an emergency?
It depends on the kind. A headache that reaches full force within a minute is a 911 call whatever else is going on. A headache after an epidural that is bad when you stand and eases when you lie flat is a different problem, a leak of spinal fluid, and that one is a same-day call to this office rather than a trip to the emergency department.
Related reading
- Herniated disc
- Compression fracture
- Cervical radiculopathy
- What to expect on the first visit
- Contact
If it is on this page you will be sent to the hospital, and if it is not you will be seen
For everything that is not an emergency, this is the number. Say where you are driving from and what has changed, and you will get a straight answer about how soon you need to be seen.
505 Buckeye Dr, Suite 200
Troy, IL 62294
Procedure clinic: 4499 Woodson Rd, St. Louis, MO 63134, off I-70 next to St. Louis Lambert International Airport. One bridge from the Metro East.
Sources
- Gardner A et al. Cauda equina syndrome: a review of the current clinical and medico-legal position. European Spine Journal, 2011. PubMed 21193933
- Darouiche RO. Spinal epidural abscess. New England Journal of Medicine, 2006. PubMed 17093252
- Downie A et al. Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ, 2013. PubMed 24335669
- Metcalfe D et al. Diagnosis of ruptured abdominal aortic aneurysm: a multicentre cohort study. European Journal of Emergency Medicine, 2016. PubMed 25969344
- Horlocker TT et al. Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition). Regional Anesthesia and Pain Medicine, 2018. PubMed 29561531