Should I Go to the Emergency Room with my Back Pain?
Hi, I'm Dr. John Shim, and I'd like to discuss why it's better to see your family physician initially for most back pain. Fortunately, most back pains do not occur because of a traumatic injury, but rather, a very innocent event like turning over in bed, reaching for a book, coughing, twisting to grab a bag, and so on. Unfortunately, most back pains do occur at the most inconvenient times. It can be a tremendous source of frustration, and when in the middle of an episode, everyone hopes we have a magic solution and it makes it go away instantly. This part most of you do not like. The truth is doctors do not have that magic solution at this time. You should see your family physician first, because she or he can do the assessment to make sure the cause of your back pain is not anything too serious. If there is no history of any kind of traumatic event, no concerns for infections or cancer, and no loss of important body functions, then the episode of back pain likely will resolve with some time, some over-the-counter medications, stretching, and activities modifications. The visit to the family physician, and evaluation should not be a very costly process. With some assurance, and guidance, greater than 90% of the episodes will improve without the need of anything more than the examination and advice. While everyone says cost should not be a factor when it is about their health, I find that very few people actually want to spend their own money to manage their healthcare needs. In this scenario of nuance of back pain, the most cost effective way to manage back pain is to see your family physician. Now, if things do not improve, or there are concerns about something more serious, then your family physician can make a referral to a specialist, or advise you to go directly to the emergency room. But we have to be Frank, the cost will certainly escalate. The truth is, even the more significant episodes of back pain, there is still be an excellent chance that there will be resolution over time without the need of any aggressive treatments. But, on the other hand, to rule out anything too serious, there will be the additional testing, specialist consultations, procedures, and the anxieties, along with the costs will be significant. At the end of it, as long as you are better, it does work out. The costs however, may take awhile to resolve. This is Dr. John Shim discussing the role of the family physician for episodes of back pain and costs. Thank you for watching our video.
A Quick Lesson – Emergency Room or Not
At some time or other most of us will have back pain. What people need to know is what is a dangerous back pain and what is something you must just get through. I get asked many questions about this so I thought we could answer some of the most common. Please do not diagnose from these recommendations. They are just a guideline.
What should I do first after the injury?
The first thing you should do is assess what is happening to your pain. Is it a sharp or dull pain? Does it radiate anywhere? Is it constant? Does it hurt with certain movements? Is it bearable?
How do I treat the pain initially?
Acute back pain should be treated with ice and rest. 20 minutes of ice at a time is adequate and should be applied several times a day. Over the counter anti-inflammatories (if you are able to take them) should decrease the pain.
What else is happening to my body?
Do you notice any weakness or numbness and tingling? Are you able to walk? Are you having a loss of control of your bowel or bladder? Is there some type of sexual dysfunction?
Why would I go to the ER?
The above symptoms of weakness or loss of control are a reason to go to the emergency room. It generally means there is pressure on the nerves to the pelvis and lower extremities and if not dealt with quickly, can lead to permanent damage. It is called “saddle anesthesia” and is one of the first things that need to be assessed with a reported back injury.
What would they do in the ER?
After an exam, radiological studies will be performed to see what is causing the pressure on the nerves. There could be infection, a tumor, or most often with acute pain, a fracture or a herniated disc. A strong anti-inflammatory, such as an IV steroid, is given to decrease the swelling and therefore decreasing pressure on the nerves.
When is surgery necessary?
Surgery is necessary if the pressure on the nerves does not decrease with the medication, if the paresthesia continues, or if the symptoms worsen. It can be a simple discectomy or a larger decompression, depending on the problem.
If I don’t need surgery, what should I do?
Once it is considered safe, you can gradually increase your activity. Anti-inflammatories and muscle relaxers make movement easier. Time stretching, and in physical therapy, can be beneficial for the pain right now and to prevent future exacerbations.
- Chenot JF. [Low back pain: focused history taking and physical examination]. Dtsch Med Wochenschr. 2018 Oct;143(21):1556-1563. PubMed PMID: 30336508