Low back pain is ominous when it is caused by something that can cripple or kill you. “Ominous” is medical jargon for “truly scary.” Cue Jaws theme music. But your typical case of chronic low back pain, as nasty as it can be, has never killed anyone. I have worked with many truly miserable chronic low back pain patients, and of course the huge economic costs of back pain are cited practically anywhere the subject comes up. It can definitely be “serious” even when it’s not dangerous. Chronic low back pain is serious … but rarely ominousīack pain can suck the joy out of your days for week, months, even years. The main text is written for patients, but it’s also extensively referenced for keen readers and healthcare professionals. There aren’t any easy answers for stubborn back pain, but there is evidence-based hope, and the back pain tutorial explores the topic extremely thoroughly. This article might ease your mind, but what about your back pain? If your pain is becoming chronic (4-6 weeks), or if you just keep having flare-ups, you may want to dive much deeper into the topic. 10) In other words, this article explains the difference between “dangerous” and “just painful” as clearly as possible. (It’s basically just a plain English version of clinical guidelines for doctors. This is a concise, readable guide to symptoms that need better-safe-than-sorry investigation with your doctor. 9 The further you are from 55, the better your odds.īut how can you tell? It can be tricky. 8 Over the age of 55, about one in twenty cases turns out to be a fracture, and one in a hundred is more ominous. Once in a while back pain is a warning sign of cancer, autoimmune disease, infection, or a handful of other scary culprits. Of course there are cases of low back pain that have alarming causes, but it’s reassuringly rare. Or you could be dying! What are the odds that back pain is something scary? 6 Sadly, many healthcare professionals continue to perpetuate the idea of fragile backs, 7 which undermines that valuable confidence. The power of justified, rational confidence is a huge factor in back pain. Most patients are much better off when they feel confident about these things. 4 Indeed, nearly every scary thing people think they know about how back works is either exaggerated or a full-blown myth. MRI and x-ray for low back pain are surprisingly unreliable, 1 because things like bulging discs usually aren’t a big deal, 2 most back pain goes away on its own, 3 and trigger points (“muscle knots”) are common and can be worrisomely intense but aren’t dangerous. Even when it’s unusually severe and/or constant, it probably isn’t dangerous. The pain almost always makes it seem worse than it is. The bark of low back pain is usually much worse than its bite. And the absence of red flags is not remotely a guarantee that you’re in the clear - but it’s a good start. Red flags do not confirm that something horrible is going on, just that it’s time to talk to a doctor. Note that signs of arthritis are not red flags. Most of that 1% is cancer, autoimmune disease, and spinal cord damage.ĭon’t medically investigate back pain until it’s met at least three criteria: (1) it’s been bothering you for more than about 6 weeks (2) it’s severe and/or not improving, or actually getting worse and (3) there’s at least one other “red flag”: age over 55 or under 20, painful to light tapping, fever/malaise, weight loss, slow urination, incontinence, groin numbness, a dragging toe, or symptoms in both legs like numbness and/or tingling and/or weakness. Only about 1% of back pain is ominous, and even then it’s often still treatable. The most worrisome kinds of back pain rarely involve severe pain, and many common problems (like slipped discs) are mostly much less serious than people fear. The pain of back pain usually makes it seem worse than it is.
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