Jeffrey R. Carlson, MD
Severe back pain can be a sign of several significant spinal disorders that bring patients to consult with me, as a spine specialist. Although most back pain, even severe pain, is not going to be a symptom of a severe or life-threatening disorder, most people’s thoughts immediately go to the most extreme possible causes when they are suffering. Cancer, infections, and fractures are the most consequential disorders that cause severe back pain, but they are also rare.
Most commonly, the genesis of back pain caused by a fracture can be traced back to a specific accident or injury. Spine cancer diagnoses are unusual and more often coincide with cancer or a tumor in another part of the body that has metastasized or spread to the spine. Infections can develop slowly and may be quite far along before a patient will seek medical attention for pain.
A recent study from The American Journal of Emergency Medicine (May 2019) reviewed patients that came to the ER for evaluation of severe back pain, who were eventually diagnosed with a spinal infection. Over the period of 14 years, the researchers identified 232 patients whose symptoms caused the ER physician to suspect a spinal infection. Of these symptomatic patients, only 89 (38%) actually had a spinal infection.
They were able to take the characteristics of the patients and make a profile of those patients that are more likely to have a spinal infection. Eighty percent of these patients had recently been treated for a soft-tissue infection or bacteria in the blood stream, were male or had a fever in the ER. Intravenous drug use was the most common reason for bacteria in the blood stream. Patients that come to the ER with back pain that are 1) male, 2) IV drug users and 3) have had a recent fever will be more likely to need an evaluation for potential spine infections. If these three constants do not apply in your case, then a spine infection is most probably not the cause of your back pain.
This algorithm helps physicians and patients rule-in or out a spine infection as being the cause of their back pain. Patients should keep in mind the other causes may not be less painful, but will certainly be less detrimental for their health. Talk with your physician concerning your back pain and any contributing factors that may have caused you to seek treatment.