Back pain is one of the most common reasons for visiting a practice, and in the vast majority of cases there is nothing dangerous behind it. The guidelines speak of “non-specific” low back pain when no serious cause can be identified. That is the normal case. There is, however, a small number of signs that need to be judged differently. In medical terminology they are called “red flags”, and they are the reason why doctors ask a few specific questions about every case of back pain.
This page is not meant to frighten you. It is meant to help you recognise the few situations in which waiting is the wrong decision.
Immediately: call 112 or go to A&E
With these signs, time matters, because nerve tissue under pressure suffers damage that does not recover. Do not wait for an appointment, not even until the next morning.
- Numbness around the buttocks, the area between the legs and the inner thighs. Doctors call this “saddle anaesthesia”, because it corresponds to the area that rests on a saddle.
- New problems passing urine or opening your bowels. You cannot go, even though your bladder is full. Or you no longer notice that you need to. Or you lose urine or stool without noticing.
- Rapidly increasing paralysis. A foot that catches when you walk. A leg that gives way when climbing stairs. A hand that can no longer turn the key. When this gets worse within hours or days.
Promptly: see a doctor within a few days
These signs are no reason to call an ambulance, but they do not belong on a waiting list either. Call us and tell us what it is about, and we will find an appointment at short notice. Alternatively, contact your GP practice or the out-of-hours medical service on 116 117.
- Weakness in a leg or arm that is not deteriorating rapidly but is new.
- Back pain with fever, especially after an infection, an injection or an operation on the spine.
- Back pain after a fall or accident, above all with known osteoporosis or in older age, even after seemingly harmless falls.
- Pain that gets worse at night and does not ease at rest, unintentional weight loss or a known history of cancer.
- Neck pain with unsteadiness when walking, clumsiness of the hands or a feeling of “walking on cotton wool”. This can indicate involvement of the spinal cord.
Not an emergency: symptoms without warning signs
Low back pain that spreads into the back or buttocks, sciatica radiating into the leg, neck pain radiating into the arm: this is unpleasant, often very painful, but in the vast majority of cases not dangerous. As long as none of the signs listed above are present, a regular appointment is the right way. Keep moving as far as you can, and do not let yourself be frightened by a report you have not yet discussed.
For back pain without warning signs, the German National Disease Management Guideline even expressly advises against taking images straight away. A report that was not needed causes worries that were not there before.
If you are unsure
Call us. Describe what you feel. Uncertainty is a good reason to call, not a bad one. On the telephone we can assess whether a regular appointment is enough, whether we should see you at short notice, or whether you should go straight to an accident and emergency department.