Lower back pain may be serious if the pain lasts for over a week, radiates to other parts of the body, or is accompanied by other symptoms

Lower back pain is common, affecting over 80% of people at some point in their lives. It is usually caused by poor posture and tends to go away on its own. However, lower back pain may be serious if the pain lasts for over a week, radiates to other parts of the body, or is accompanied by other symptoms.

Typical symptoms of lower back pain include:

• Shooting, burning, or aching pain
• Tightness or stiffness in the muscles, especially after long periods of lying down, sitting, or standing
• Trouble sleeping or lying down
• Weakness in the lower extremities (numbness or tingling in one or both legs)

8 signs that your lower back pain is serious

1. Pain for over a week: In most cases, back pain resolves within a few days. If the pain persists for more than a week, it may be time to see a doctor. Your doctor will perform tests to help determine the cause of your pain before it becomes a bigger problem. As with many other health issues, early treatment is critical.
2. Pain radiating to other parts of the body: If your back pain is accompanied by shooting pain down the leg or pain in other areas of the body, you should seek medical attention. This could be an indication of sciatica, a type of pain that affects the sciatic nerve, which runs from the lower back down the buttocks and down each leg. Sciatica is often caused by a herniated disc. 
3. Pain following an injury: If your back pain is caused by a car accident, fall, or other type of injury, it may indicate a serious issue such as a fracture that needs to be addressed.
4. Pain accompanied by pins and needles, numbness, or weakness: Back discomfort accompanied by numbness, tingling, or weakness could indicate nerve irritation or injury. This is especially true if the discomfort persists after taking over-the-counter pain medicines. Nerve discomfort is dangerous and, if left untreated, can result in lifelong damage or disability.
5. Worsening of pain with certain positions or during a certain time frame: Sometimes, significant back pain may occur only in certain positions or wake you up in the middle of the night. This could be an indication of a more serious problem such as an infection, fracture, severe nerve compression, or even malignancy.
6. Pain with bowel movements or urination: If your lower back pain is accompanied by lack of control over your bowel movements or urination, you should seek immediate medical attention. This could be a sign of cauda equina syndrome, in which the nerves in the lower spine have been compressed. Although a rare condition, if left untreated, it can cause lifelong nerve damage that requires surgery to decompress the nerves and regain their function.
7. Pain with fever: Lower back pain can sometimes be accompanied by fever if you have the flu or another infection. However, if your fever does not respond to over-the-counter treatments, it may indicate a dangerous infection that requires emergency medical care. Consulting a doctor is necessary to identify the cause and take appropriate medications (antibiotics) in case of an infection.
8. Unintentional weight loss: If you experienced unexplained weight loss along with your lower back pain, consult a doctor to rule out more serious conditions such as an infection or tumor.

What is acute vs. chronic back pain?

Back pain is categorized into two types:

Acute back pain

Acute back pain is also referred to as short-term pain because it starts and builds up over a short period. Stress, excessive exercise, an awkward movement, or improper lifting techniques can all contribute to acute back discomfort. 

Shooting, burning, or aching pain that occurs suddenly is the most prevalent sign of acute back pain. Acute back discomfort usually lasts no more than 6 weeks and can be relieved in as little as 2 weeks with a little time and home remedies such as over-the-counter pain relievers and cold and heat therapy. In most cases, the underlying source of pain isn’t a major or long-term issue. If, however, the pain is severe or interfering significantly with daily activities, you should seek medical help.

Chronic back pain

Chronic back pain may be due to a serious cause and symptoms are often severe enough to have a long-term effect on your health, mobility, and quality of life. Although persistent back pain might strike suddenly, it usually develops gradually and lasts for more than 6 weeks. 

Chronic back pain can be recurring, which means that it will go away for a while but then return. A fresh injury can induce chronic pain, but underlying disorders are frequently to blame. One of the most common causes is muscle deconditioning (lack of strength and stability in your back).

What are common causes of lower back pain in adults?

Common causes of back pain include:

• Lifting heavy objects
• Repetitive bending 
• Excessive stretching
• Injury from falls
• Sedentary jobs that require prolonged hours of sitting
• Jobs that require vigorous physical activity
• Obesity
• Smoking

Spine disorders can also cause lower back pain, and symptoms can typically be controlled with physical therapy, medicine, injectable anesthetics, or a combination of treatments:

• Ankylosing spondylitis: This is an inflammatory condition that causes the spine to become inflexible, resulting in a constant hunched posture and back pain.
• Degenerative disc disease: The bones in the spine (vertebrae) have cushion-like structures between them called discs. These discs can get damaged and cause pain and other issues due to compression of nerves.
• Sacroiliitis: This is an inflammatory condition seen in the joints that connect the pelvis to the spine. The condition can cause pain in the lower back, glutes, and upper legs.
• Adult degenerative scoliosis and kyphosis: These are spine curvature disorders. If the spine curves toward the sides, it is called scoliosis, and if the spine curves outward and causes a hunchback, it is called kyphosis. Both scoliosis and kyphosis cause back pain and lower extremity weakness.

In rare cases, conditions unrelated to the spine can also cause back pain:

• Kidney and digestive problems, such as pancreatitis and gallstones, can cause lower back pain that may be mistaken for spine pain.
• Uterine fibroids and endometriosis can cause abdominal pain that can radiate into the back.
• Rarely, a person with severe back pain may be diagnosed with a ruptured aneurysm, which is a weakening and tearing of a blood vessel.
• Similarly, aortic dissection, the rupture of an inner layer of tissue in the aorta (the main vessel that transports blood from the heart to the rest of the body), can produce back pain and be fatal if not treated immediately.

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How is lower back pain diagnosed?

Your doctor will take your complete medical history and take note of any physical activities that may have caused injury to the back. During physical examination, you may be asked to perform movements to detect whether there are any deformities or pain radiating to other areas. Neurological examinations may be done to check for muscle strength and reflexes.

• Radiological tests: X-ray and magnetic resonance imaging (MRI) may be done to assess spinal alignment and look for deformities.
• Bone scan: Bone scans can detect certain spine diseases, such as spondylosis (spinal osteoarthritis), fractures, and infections. A small amount of a radioactive material is injected into a vein, and areas with the most radioactive material, referred to as hot spots, will show abnormalities such as inflammation or tumor.
• Myelogram: A unique dye is used to determine whether you have a spinal canal or spinal cord issue. A myelogram also includes an X-ray or computed tomography (CT) scan to detect any abnormalities.
• Discogram: A discogram can confirm whether your intervertebral discs are the source of your back pain. It involves injecting a dye into one of your discs; if there is an issue with a disc, the dye will seep out of it.

What are the treatment options for lower back pain?

Treatment of lower back pain relief depends on the cause, duration, severity, location, and whether your pain is structural or muscular.

Nonsurgical treatment

• Administration of anti-inflammatory and prescription pain drugs and muscle relaxants
• Ice and heat packs
• Wearing supportive shoes
• Performing gentle stretches
• Physical therapy
• Changing mattresses if necessary
• Reducing anxiety and stress

Surgical treatment

Decompression procedures remove whatever is pressing on a nerve root in the spinal column, which could be a herniated disc or bone spur. There are two main types of low back pain decompression:

• Laminectomy: Laminectomy is a surgical procedure that removes a portion of the layer of bone or soft tissue that is crushing a nerve root. It is usually performed on someone who has leg pain and/or weakness due to spinal stenosis caused by changes in the facet joints, discs, or bone spurs.
• Microdiscectomy: Microdiscectomy is a minimally invasive procedure used to treat those who have radicular leg pain caused by a lumbar herniated disc.