When to go to the ER for back pain

Most back pain improves with rest and home care, but certain symptoms require immediate medical attention. Understanding these warning signs helps you make informed decisions about emergency care and could prevent permanent damage to your spine or nerves.

Emergency warning signs

“Back pain that comes on suddenly and severely, especially after a fall or injury, should be evaluated right away,” says Claire Nelson, DO, a primary care physician at Mount Nittany Health. “Head to the ER right away if your back pain comes with loss of bladder or bowel control, weakness or numbness in your legs or trouble walking — these symptoms signal serious nerve compression or spinal cord issues.”

Additional symptoms that indicate the need to seek emergency care include:

• Numbness in the groin or pelvic area
• Pain that wraps around to your abdomen
• Fever with back pain

The combination of symptoms often provides important clues about the underlying condition. For example, fever with back pain may indicate an infection, while loss of bladder control and leg weakness could indicate nerve compression.

Understanding emergency back conditions

Most back pain doesn’t need emergency care — but in some cases, getting help right away is critical.

“If you’re experiencing sharp, constant or rapidly worsening back pain — especially if it comes with numbness in your legs or sudden bladder or bowel issues — don’t wait,” explains Dr. Nelson. “On the other hand, if you’re dealing with mild to moderate back pain that doesn’t involve trauma or nerve-related symptoms, following up with your primary care doctor or visiting an urgent care may be appropriate for pain relief and guidance.”

Other serious conditions include:

• Abdominal aortic aneurysm, causing severe lower back and abdominal pain along with rapid heartbeat or cold sweats
• Spinal infections, accompanied by fever, unexplained weight loss and possible redness or swelling
• Spinal fractures, especially concerning in those with osteoporosis or recent trauma
• Severe nerve compression causing progressive weakness, numbness or bowl/bladder incontinence

The conditions can worsen quickly without proper medical intervention. Knowing their symptoms helps you recognize when emergency care is necessary.

Making the right care decision

Deciding between emergency care, urgent care or waiting for a regular appointment can be a challenging decision.

“Many people think they need to go to the ER for every type of back pain, but most back pain is not an emergency,” notes Dr. Nelson. “If it’s a chronic or manageable flare-up, it’s better to start with your primary care provider or urgent care.”

You need emergency care if you experience severe symptoms and have any of these risk factors:

• History of cancer
• Compromised immune system
• Blood thinner medication
• Recent trauma or injury
• Age over 70
• Diagnosed with osteoporosis
• Recent spine surgery
• Progressive neurological symptoms

You can consider urgent care or PCP care for:

• Chronic back pain without new symptoms
• Mild to moderate pain that improves with rest
• Pain that doesn’t limit your movement
• Muscle soreness after activity
• Gradual onset of symptoms
• Pain that responds to over-the-counter medication

What to expect at the ER

Knowing what to expect in the emergency department helps reduce anxiety about seeking care.

“When you go to the ER for back pain, the medical team will begin with a physical exam and questions about your symptoms, recent injuries and medical history,” says Dr. Nelson. “Depending on what they find, they may order imaging like X-rays, a CT scan or an MRI to look for fractures, herniated discs or other serious problems. The provider may also order bloodwork if they suspect an infection or inflammatory condition.”

When you arrive in the emergency department, the medical team will check your vital signs, review your symptoms, perform a brief neurological exam and assess your pain levels. They will also review your medical history and document your current medications.

Treatment typically begins during the evaluation process. Treatment often includes pain management and measures to prevent further injury.

After emergency care

Emergency departments focus on ruling out serious conditions and stabilizing patients. This visit is just the beginning of your healthcare needs to resolve your back pain.

After a visit to the emergency department, you will need follow-up care. This could include appointments with spine specialists or your primary care physician who may order additional imaging studies. Your provider may also refer you to physical therapy or pain management. Other follow-up care may consist of adjustments to your medication or home exercise programs to help alleviate your pain.

Your healthcare team will create a comprehensive treatment plan based on the emergency department’s findings and your specific needs.