Back Pain: Should I worry it could be something more serious?
Back pain is the second most common reason for a visit to the physician. By far the most common causes of low back pain are "mechanical" caused by disc degeneration, muscle or ligament strain. Rarely, acute low back pain is a harbinger of serious medical illness including infection, cancer, and other diseases. Patients often come to see me concerned that a serious underlying illness could be causing their low back pain. Here are the illnesses patients worry about followed by why I don't think you need to worry.
1) Kidney stone: Yes this could be the cause of your back pain if your pain is a 10/10 on the pain scale, constant, crampy, aching and so severe it's making you nauseous and you can't sit still.
2) Kidney failure: A very unlikely cause of your low back pain given that yes, the kidneys are stationed back in the flanks, but kidney failure doesn't cause low back pain. Period.
3) Kidney tumor: Cancer of the kidney is a rare cause of low back pain especially if the pain was accompanied by blood in your urine, weight loss and fever. If you or your physician can feel an abdominal mass and you were a smoker, then I'd really worry.
4) Metastatic cancer: Unlikely that cancer has spread to your bones (prostate, breast and lung cancer do this most commonly) and caused your low back pain unless your pain has become very severe quickly, is not relieved even with strong pain medicines, and is associated with neurologic complaints (numbness and tingling). Oh and you should also have weight loss and fatigue.
5) Multiple Myeloma: While it's true that Multiple Myeloma often presents with low back pain you should also have weakness, fatigue and notice that you are pale. Shooting pain that radiates down your legs would also raise some red flags for Multiple Myeloma if accompanied by the above findings.
6) Abscess in the spine "Epidural Abscess": These are rare but could be your issue if your back pain started out as a focal severe pain then turned in to shooting or "electric shocks" throughout your back. To worry about an abscess or infection in the spine I'd also like to see weakness, urinary retention, and numbness or tingling.
7) Fracture of the spine "Compression Fracture": Unless you are older with osteoporosis this is not likely your issue BUT if you had acute back pain after sudden bending, coughing, or lifting well, then, this could be a potential are of concern. The pain from a compression fracture, unlike other worrisome causes, rarely radiates to the legs and is worse with sitting or moving.
8) Tumor in the spine causing spinal cord compression "Cauda Equina Syndrome" : If you have the acute onset of urinary retention, bilateral leg weakness and numbness, then and only then can you worry about this
9) Multiple Sclerosis: Unlikely given that while back pain does occur in early Multiple Sclerosis it won't do it without sensory changes like numbness and tingling in your limbs, visual problems like double vision and a good dose of fatigue.
Hope this helps alleviate some of your concerns and jump in if you have any more to add!
Dr O.
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17
Dr Orange, I have a question? I have been seeing a Dr. @ a NEUROSCIENCE CLINIC! & the Dr. there has given me several dianosis. He has also given me several Injections in my back & neck, but mostly my Back, especially my LOWER BACK. He has now Recommeded me to a NeuroSurgeon Dr.! Dr. O, Recentally, we found out that Adenocarcinoma, runs in the family! My Gradma passed away in 1995 of Renial Red Cell Carcinoma, & now just out of the blue my Aunt has been diagonsed with Adenocarcinoma, It started in her GallBallder, & had to be removed, It was allready rotted & begining to stick to her intenstines, It has spread to almost all of her Organs now, & is on Hospice. My Grandamas Kidney had a rotted ball the size of a grapefruit, & it was removed & was also on Hospice till she passed away in 1995. My Question to you is, if I had anything like that, surely it would of showed up in the MRI's, & X-Rays I have had, Am I correct? Please HELP I Need to know, I need your ADVICE!!!!!!!!!!!! THANK YOU!!! KAT
By recycling December 20, 2008 2:18am
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Hey thanks for the info Doc. I have 2 herinated discs L4 & L5, L5 & S1 and have been doctoring with this since it first happened in Oct. of 2002 and have seen a reg. MD and did the therapy thing countless mediciations, traction home and at the hosp. seen a chirocpractor it wsa getting a little better but than back to work doing wheelchair buses yea great for the back and been off of work since 2003 again seen many doctors had MRI, discogram, and some other tests, even injections none of which has helped the discogram said that there was some leaking in there should I be afraid of this or what? No doctor has really done anything to me since this is a work comp claim and now I have been trying to get onto Social security and still having major pain the doctors I see now can only give me flexoral since it is at a freee clinic they really can't give out anything stronger. Do you have any suggestions upon what I can do? Oh yea loss of bladder control and I can step on things and other people have to tell me that there is something stuck to the bottom of my foot. Thank you and sorry for the spelling. From the ZIP
By zip November 20, 2008 11:33pm
15
Dr. Orange - I'm sorry if my blog was a little harsh. You're right on -- kidney cancer is RARE and my dad did smoke -- but that was long, long time ago -- when it was fashionable.
Glad there are docs who are well versed and willing to share their knowledge.
AWESOME.
I'm so scared about my dad. His kidney was removed and it spread to his lungs. Now he's on a targeted chemo -- starts with an S. He has sore hands and feet and feels bad all the time. It's a pill he takes. He's scared I know.
My mom has thrombocystiosis. She has side effects from her medication that causes cellulitis. She is tough psychologically. My dad gets down though.
Thanks again. I'm going to reread your story. My back hurts sometimes too to tell you the truth! It might help to allay the hypochondriac in me.
By FeelingRough November 8, 2008 5:45pm
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Annie56, I am not a doctor nor is this intended as medical advise. I have and am suffering from much of wich your report covers. I don't think your 1999 staph infection is the cause of what looks to me to be what has been diagnosed in me as "degenerative spine disease". I have had 3 surgeries so far and have fusions on multiple levels from cervical to lumbar areas. There is hope. You have to find the right surgeon. I am now undergoing the looky see stage with a surgeon who specializes in Carbon Fiber spinal cage systems. I have been in contact with a gentle man who has had this done by this surgeon on his entire lumbar and lower thoracic spine. He is my age and very active and pain med free. I am impressed with his abilities. I ride a wheel chair, as he did, and am on narcotics as you are and he was. So there is hope and help is out there, don't give up. Seek and ye shall find. This surgeon is in Tennessee, Nashville area.
!st,2nd,3rd,4th opinions and so on, perseverance and you will find your way. Off the top of my head he operates out of the Centennial Medical Center in Nashville, Tn.
By DeltaLimaTango October 22, 2008 8:35am
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What is the back pain worsens when u breathe in the lateral rib cage ?
By kgmorris22177 October 18, 2008 10:24pm
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To put it another way, trust YOUR instincts.
NOT THE DOCTOR.
They're only human and can be VERY quick to dismiss folks -- stress and the like.
It ain't fun being sick, and a lot of times there are early clues. Not every doctor is like the show House. Many like to make a good living. And that is how they define success. If they cure a few patients along the way, then yeah, they're doing their job. But it's when it's not cut and dry, well, let's face it, they hang up their lab coat and go home. House on the other hand, NEVER does that.
Where are the Dr. HOuse's of the world.
By FeelingRough October 16, 2008 7:58am
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genebh: that was the whole point of this...generally you have NOTHING to worry about and in fun...i tried to spell out what kinds of changes you should have to start to worry about your back pain....
By DrOrrange October 14, 2008 12:37am
10
ITEM 3 and 4. You need to worry about back pain if you have cancer that runs in the family. And you have to check your family history on forms in the a doctor's office.
My father's rare kidney cancer went unchecked as he, too, went to the doctor 3 or 4 time complaining of backpain.
He lost a kidney (tumor). And then it spread to his lungs, as kidney cancer does. SO, the moral of the story is TRUST YOUR INSTINCTS and NOT THE DOCTOR. Get a second, third and fourth opinion. And let them all call you a hypochondriac -- so be it. He'd be in better shape today if he would have.
Just trying to be helpful.
By FeelingRough October 12, 2008 7:28pm
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Do we really need to know all this crap? Like parents of SIDS babies, we worry about EVERYTHING. Like side effects from meds, they occur RARELY. EVERY possibility just scares the bejeepers out of someone. Is this Fair? Only deal with what you have before you not your pipe dreams. We need hope not new fears.
By genebh October 2, 2008 10:27pm
8
Just wanted to sing the praises of radio-frequency ablation. I had 3 LESI's fail and was in severe nerve pain and on a lot of med.s from April to August. The test for the procedure was HORRIFIC, but since the actual procedure, I have been free of nerve pain. I now operate on about a third of the med.s and about a third of the pain level. I can work and SIT UP!!! Conditions include spondylolisthesis with severe nerve compression on the right, moderate on the left, bulging disc, disc degeneration S1, L5, L4 (pretty much no disc mat'l left, but all calcified together - dr.s kept saying things like chisel, hammer, saw, and DIDN'T want to do surgery). I will never have another LESI and hope to avoid surgery by continuing to get ablation. WHAT A WORLD OF DIFFERENCE!!!
By carried October 2, 2008 4:48pm
7
I have lower back pain that extends around my groin and into my upper thigh to the knee, it came on very suddenly in may 08, i was eventually diagnosed with a femerol Artery injury causing femerol artery nueropathy pain.
I was bed bound for 9 weeks unable to move and in excrusiating pain, im now out of bed and much better but still unable to work as im aCNA, i cant lift or bend ect.
Simple things like walking my dogs or being fairly buisy around the house put me hobbling and in pain.
I have asked my doctor if i will eventually heal or will it not get any better than it is now.
Iv,e treid to find info on line but it,s not very indepth and im feeling frustrated because im stuck in the house and unable to work with no real answers.
I also notice if iv,e been buisy doing housework i get very sore muscles like i have worked out as well as being in pain.
Do you think i need more exercise and could you shed some light on complete recovery and time frame for this, like i said t,s been since may so far.
I would appreciate any feed back.
With thanks!
By DogCrazy October 2, 2008 3:49pm
6
My mother has chronic back pain due to falling and resulting with a compression fracture. We bought her a nice life chair from the medical supply store and we use tiger balm, patches. This has helped her a lot. By the way mom is 87 years young
By jinkx50 October 2, 2008 9:27am
5
Hi, My name is Annie. In 1999 an epidural that was left in top of my spine for 8 days caused Staph infection. I now have spinal disc disease, Nerve pain, numbing, tingling, alot of weakness in my legs. I cannot walk more than 5 minutes without alot of pain especially in a bone in mid of my spine. Complained about this bone since 2000 to specialist and dr but they won't tell me why it hurts so much. MRI showed in July this yr..c4/5 disc has posterolateral osteophytes and disc bulge causing minor degree of canal narrowing. Foraminal narrowing on both sides. C5/6 disc has posterolateral osteophytes and disc bulge causing minor degree of canal and right sided foraminal narrowing. Spondylotic changes in mid cervical spine at C4/5, C5/6. C6/7. mild forward slip of C3 onC4 .AP Diameter of spinal canal in reduced at C4/5 level due to spurring, disc protrusion and fat arthrosis. Changes extend into the uncovertebral joints, particularly on right at C4/5.This is contributed to byh prominent spurring and a right paracentral disc protrusion. There are severe spondylotic changes at C4/5,C5/6 AND C6/7. At C4/5 Level a right paracentral moderate disc protrusion results in tight canal stenosis and distortion of the thecal sac. It is felt that there is artifactual high signal noted on the axial T2* Scans in the cord as they are not present on the sagittal scans. I suffer alot of chronic pain, am on oxycontin and trying to detox myself off this by starting on Gabapentin. The specialist and my dr won't talk to me about what all this means and all I know is I am suffering alot of pain from neck to feet. Please if there is someone out there who understand all I have just written from my reports please could you explain it to me. I am so scared I will end up in a wheel chair. Specialist said there is nothing they can do for me but to continue to increase the Oxycontin as I continue to worsen. This depressed me to such a place of no hope. But I am not going to let them turn me into a vegetable. I have successfully detoxed in past 2 weeks from 60mg Oxycontin twice a day, down to 40mg twice a day. I am trying so hard to rise above what those drs did to my spine. This all started in 1999 my left hand was turning blue so they put the epidural in top of my spine to pump drugs through to stop this blue painful thing in my hand. I had a perfect spine before this. Also my spineis now shaped like an 'S'. Can someone please tell me what is happening to my spine and what do I have to look forward too in the future. Is there Hope? Thankyou. Annie
By Annie56 October 2, 2008 7:49am
4
How come some injuries never heal without an apparent reason? Now, I am stuck with pain that makes aggrevates my seizures and no one knows why??
By Maika October 1, 2008 10:14am
3
Hello!
Back pain is serious medical illness. The most common reason of low back pain is muscle strain. The information you had mentioned above is quite sufficient. Thanks to you.
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By Ifra September 30, 2008 7:24am
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DR. PLEASE READ MY TOPIC BOWLING VS SURGERY AND COMMENT BACK
By BUTTERFLYWOMAN September 29, 2008 3:44am
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I've been dealing with a sore back for a number of months. I am between jobs (that's respectable sorta) and have not sought chiropractic help. So I've been laying on the floor and doing stretches to help, and it does but, frankly, I am waiting for alleviation of the symptoms. Any suggestions are welcome.
By scooby3 September 27, 2008 11:11pm