Since back pain is so common, how do we decide if our back pain is not typical or harmless?
Here are some symptoms that you should pay attention to:
If your back pain
- Comes with lower limb pain, numbness or weakness
- Comes with fever or night sweats
- Worsens at night or at rest
- Comes with unexplained weight loss or loss of appetite
- Comes with other joint pains
- Lasts longer than 6 weeks
If it comes with lower limb pain, numbness or weakness
Our nerves supply the functions of sensation and strength. When back pain is associated with these symptoms, it usually indicates an element of nerve compression. Hence this needs to be properly evaluated as chronic compression on neural elements may lead to permanent damage and an irrecoverable situation. Nerve compression could be due to a prolapsed disc (fall out of place), fracture, infection, cancer or severe degeneration of the spine.
If it comes with fever or night sweats
When the back is afflicted with pain that is associated with fever or night sweats, this could indicate an infective or inflammatory condition. Infective causes of back pain are typically from bacterial infection or tuberculosis, which if left untreated, may lead to collapse of the spine and eventual paralysis or neurological damage. Inflammatory causes like an auto-immune disease for instance, ankylosing spondylitis or rheumatoid arthritis, can cause fever with back pain, especially when the disease is flaring up.
If it persists at night or at rest
Usually, our pain improves with rest, and may subside when we sleep. This is typical of muscular pain as the muscles are no longer in spasms in our restful state. Back pain that persists at night or at rest typically implies pain that results from a destructive process in the spine. Typically it is due to cancer or tumour, or infection that is eroding away the spinal structure.
If it comes with unexplained weight loss or loss of appetite
Back pain is unlikely to persist and result in prolonged loss of weight or appetite. Usually when there are these latter symptoms, there is a root cause of the weight or appetite loss. Typically in late stage cancer, our body loses weight and we lose appetite, due to the terminal stage of the disease. In such a situation, it is not uncommon that the cancer has also spread to the spine, which explains the accompanying back pain.
If it comes with other joint pains
Usually, back pain occurs in isolation if it is due to a muscular cause. When back pain is accompanied by other joint pains, it may indicate a larger cause of these combined pains ongoing in the entire body. Typically this is due to an auto-immune disease that affects multiple joints in the body.
If it lasts longer than 6 weeks
‘Regular’ harmless back pain usually resolves within 2 – 4 weeks. Pain that persists for longer than 6 weeks typically requires further evaluation. Conditions that can result in back pain that lasts this long are fractures, cancer, infection or auto-immune disease. These conditions need to be evaluated by a physician or surgeon.
If you experience any of these symptoms, or if your back pain lasts more than 6 weeks, it is time to take your back pain seriously and seek attention from a doctor.
Article reviewed by Dr Chua Soo Yong, orthopaedic surgeon at Parkway East Hospital