You recently injured your back
This one’s obvious: Whenever you directly injure your back—say you fall, get in a car accident, or something hits you on the back—you’ll want to see a professional. “You very well could have a spinal injury,” says Dr. Troy Madison, an emergency room physician, on the podcast ER or Not. “That’s a very serious thing.” Madison recommends going to the ER. There, you’ll probably need an X-Ray or CT scan to assess the injury.
You’re losing weight
Rapid, unexplained weight loss is never a good sign. And when it’s accompanied by back pain, it could be a sign of a tumor in the spine. “A tumor can weaken vertebra, leading to fracture and pain, and it can also compress the spinal cord or its branches, leading to weakness, incontinence, and many other problems,” write Drs. Christopher Kelly and Marc Eisenberg, in the upcoming book, Am I Dying?!. If you have a known history of cancer or are a frequent smoker, get an evaluation ASAP. Some tumors start in the spine, but more often they spread there from another location, such as the lung, breast, kidney, and prostate—which makes getting treatment fast even more crucial.
You can’t control your bladder
Back pain combined with bladder or bowel incontinence, or a feeling of increasing weakness or numbness in the legs, pelvis, and hips, could be serious. “These symptoms may be indicative of caudi equina syndrome,” writes Dr. Syed S. Rahman of Westchester Health, “which is usually caused by severe compression of the entire nerve sac in the lower spine.” An infection or tumor is often to blame.
Your pain wakes you up at night
In many cases, back pain from overuse, as well as wear and tear, will feel better when you let yourself rest. But if you’re constantly waking up from your pain—and a terrible mattress has been ruled out—it could be a sign of something less benign, such as a tumor. If your pain is combined with a loss of appetite, fever, or weakness or numbness, get an evaluation now.
You’ve got stomach pain too
Localized back pain will rarely migrate to the stomach. Stomach pain, however, can often be felt in the back, which means that your back pain could be originating from the abdomen. A serious condition to look out for? An abdominal aortic aneurysm. “Acute lower back pain that does not follow an obvious trauma or movement associated with the onset of pain, can be a symptom of an enlargement of the aorta (large artery) in the abdomen, called an abdominal aortic aneurysm,” says Dr. Rahman. If your pain is severe and continuous, get to the ER.
You’re having spasms of back and pelvic pain
If your back pain is less continuous and instead occurs in spasms, you could be passing a kidney stone. If that’s the case, you may also notice some blood in your urine. Head to the ER to be diagnosed and treated. You’ll likely be given an IV to help flush out the stone.
You have osteoporosis
If you have known osteoporosis and your back pain comes on suddenly, you could have fractured a vertebrae. Common causes could be a recent fall, lifting something heavy, or even a violent cough. The pain should go away on its own, but if it persists you’ll need to see a doctor—you might need a procedure called vertebroplasty in which cement is injected into the vertebra to strengthen it.
You’re experiencing numbness
That fact that spinal cord damage could lead to permanent paralysis should be enough to get you to the ER stat if you’re experiencing back pain and numbness, especially in the legs. This condition often indicates an injury to one or multiple lumbar nerves, writes FrontlineER.com. “Injuries to such crucial nerves can cause total paralysis if they are not attended to on time,” they say.