Back Pain in the Emergent Setting
“My back is hurting, when do I come to the emergency department?”
By Tori Coble, DO, Emergency Medicine Resident, UNC Health Southeastern
Back pain is a common complaint in the emergency department and can be divided into two categories: acute versus chronic. Acute onset back pain may occur suddenly or present gradually and last a short amount of time. Acute back pain can be a result of trauma-such as a fall or car crash. It can also result from underlying organ conditions-such as kidney stones. Chronic back pain lasts a significant amount of time, sometimes years. Back pain significantly affects the lives of individuals. Because of this, it also has a huge impact on the workforce and healthcare system.
It is helpful to understand the anatomy of the body when determining causes of your back pain. The spine is surrounded by musculature on both sides to help stabilize and protect. If you strain one of these muscles, you may feel a sharp, sudden pain, but it usually remains localized to the area. Between each building block of the spine, or vertebrae, are “discs” which serve as shock absorbers. Each disc is made up of a jelly-like substance, held in place by a tough piece of tissue. If this tissue tears, the jelly may leak out and press on one of the many nerves that course alongside the vertebrae. One might experience sharp pain and possible numbness and tingling down one or both legs should one of these nerves become affected. The spine is also surrounded by many important blood vessels and organs that can also cause referred pain.
Q: What are potential causes of back pain?
A: Physical trauma, improper body mechanics, and psychological or emotional conditions can all cause pain in the back. One can have broken bones, irritated nerves, or muscular pain. Back pain can also result from other systems within the body besides the skeletal and neurological systems. Problems with the genitourinary and vascular systems may also result in back pain. Kidney stones are notorious for causing waxing and waning back pain that occurs as the stone travels down the urinary tract. The pain can be intense, preventing the individual from getting comfortable. One may also notice blood in the urine. The aorta is a large vessel that supplies blood to all parts of the body. It lies very close to the spine. Pathology in this area can cause pain in the back. Concerning findings include a sudden tearing-like sensation in the back that may be accompanied by cold and clammy skin.
Q: When is back pain an emergency?
A: Numbness and tingling that occur in the area in which you would sit in a saddle mean that the nerves which control your lower limbs and pelvis are being affected. This could lead to loss of bowel and bladder control. This condition is called “cauda equina syndrome” and is a true emergency that requires immediate surgical intervention to avoid lifelong deficits. Other worrisome findings are loss of function within the legs, fever and chills, or non-relenting severe pain. Emergent conditions not related to the skeletal and neurological systems include kidney stones and vascular pathology-as discussed above. Come down and see us in the Emergency Department for any and all ailments, but especially these!
Remember that many ailments and medical conditions can be managed by your primary care provider or at an urgent care. UNC Health Southeastern is always available, around the clock, in the ED when you have urgent or emergent conditions that are beyond the scope of your family doctor or an urgent care center.
Dr. Tori Coble is a first-year Emergency Medicine Resident at UNC Health Southeastern. In addition to offering services you’d expect from a community health care system, UNC Health Southeastern provides a number of specialized services that are unique to our healthcare system and not available anywhere else in the region. To schedule an appointment, call our referral line at 910-735-8864. To learn more, visit UNCHealthSE.org. To submit questions for consideration for a future Frequently Asked Questions article, email unchsoutheasterninfo@unchealth.unc.edu.
