Back Pain Warning Signs You Do NOT Want To Ignore

In this medical education video, double-boarded pain specialist and neurologist Dr Sader discusses the back pain red flags that you don't want to ignore, as they could be a sign of something sinister. For each of the red flags, he discusses the associated diagnoses, workup, and treatment. About 85% of low back pain is what we call non-specific mechanical low back pain, and the remaining 15% is the topic of this video.

Urinary changes can happen when there is compression of the spinal cord or the cauda equina, as interruption of nerve signaling to the bladder leads to overflow incontinence. That compression could be due to disc herniation, but it can also be due to metastatic compression from cancer, epidural hematoma or abscess. Urgent imaging is indicated to rule out these syndromes as they often require emergent surgical decompression.

Fever combined with back pain can signal that there is a spinal infection, such as discitis, osteomyelitis, or epidural abscess. Imaging (MRI) and sometimes bone biopsy are required for diagnosis, and the treatment includes antibiotics.

Acute bony pain can happen in vertebral fractures, which are sometimes due to compression fracture in patients with osteoporosis (from chronic steroid use or after menopause), but sometimes they are due to pathologic fractures due to brittle bones from cancer mets. These can be very painful and sometimes we use cement (kyphoplasty) to augment the size of the fractured vertebra.

Morning stiffness associated with back pain that improves upon activity, is the opposite pattern of mechanical back pain, and could signal the presence of seronegative spondyloarthropathies such as ankylosis spondylitis or psoriatic arthritis, which often have extra-spinal manifestations like uveitis, tendinopathy, and gastrointestinal manifestations.

Blood thinner use, or the presence of a bleeding disorder, is another red flag as it can put the patient at higher risk for epidural hematoma.

Specific rashes, such as shingles, can sometimes lead to back pain during the rash phase but also afterward (post-herpetic neuralgia).

Abdominal or flank pain combined with back pain, could signal that the pain generator is not the spine but an abdominal aortic aneurysm or a kidney stone or kidney infection.

New numbness or weakness in the legs combined with the back pain could indicate that there is inflammation in the spinal cord (transverse myelitis) or nerve roots (Guillain-Barre syndrome).

Chapters:
0:00 Intro
0:42 Bladder Incontinence
3:06 Fever
4:35 Abdominal or Flank Pain
5:40 Vertebral Fracture
7:21 New Numbness or Weakness
8:34 Bleeding Risk
9:35 Morning Stiffness
11:25 Unintentional Weight Loss
12:17 Rash

Footage from Storyblocks (licensed).

Let's Connect:
IG:   / doctor.painkiller  
TikTok:   / doctor.painkiller  
LinkedIn:   / elie-sader-a21573217  
Website: http://www.eliesadermd.com


Disclaimer: The information in this video is provided for general informational and educational purposes only and is not a substitute for medical advice. Before taking any actions based upon such information, we encourage you to consult with your own doctor.

Sader Consulting, LLC

#backpain #medicaleducation #doctor #spine #lowbackpain