Back Pain: When It Needs an Emergency Room

Come in now — today, not tomorrow — if back pain comes with any of these:

• Numbness around the groin, buttocks or inner thighs — the area a saddle
  would touch
• New trouble controlling your bladder or bowels, or not being able to pass
  urine
• Weakness in both legs, or legs that feel like they are giving way
• A fever with back pain
• Back pain after a fall, a crash, or any significant force
• Back pain with sudden severe abdominal or flank pain, or with faintness

The first three together are the pattern that needs hours rather than days.
Nerves that are being compressed recover if pressure comes off early and often
do not if it does not. If that is you, do not wait for a clinic appointment.

Most back pain is not this. The rest of the article is about telling the
difference honestly.

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Lower-risk back pain — which is most of it

Sudden severe pain after lifting, twisting or sleeping awkwardly. Pain that is
bad in one position and better in another. Spasm that eases over days. Pain that
travels down one leg from the buttock.

All of that can hurt enormously and still not be dangerous. Severity is not
the signal here either — what matters is the company the pain keeps.

The reassuring pattern looks like this: nothing from the red-flag list,
still walking even if badly, no fever, and settling rather than escalating over
days.

That pattern is a description, not a verdict on whether to be seen. Back
pain is one of the most common reasons people come here, the imaging is on
site, and a physician can tell you in one visit which kind you have. If it is
frightening you, or you simply want to know — come in, or call (480) 237-4922.

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The honest answer about scans

Most back pain does not need an X-ray, a CT or an MRI, and having one often
makes things worse rather than better.

That sounds like a facility talking itself out of work, so here is the reasoning:
scans of adult backs very often show changes — disc wear, narrowing, arthritis —
in people with no pain at all. Finding one in someone who does have pain
does not establish that it is the cause, and it reliably produces worry,
further tests and occasionally treatment aimed at something that was never the
problem.

We scan when the answer would change what we do — which is what the red
flags above are for. That is a different thing from scanning because the pain
is severe.

If you have been told previously that you need imaging for this, or you have a
cancer history, osteoporosis, or take steroids or blood thinners, that changes
the calculation and you should say so when you arrive.

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Groups where the threshold is lower

• A history of cancer, particularly breast, prostate, lung, kidney or
  thyroid. New back pain deserves assessment, not reassurance.
• Over 50 with new back pain, and especially over 65
• Osteoporosis, long-term steroid use, or a previous fragility fracture —
  a fracture can happen with very little force
• A weakened immune system, or injecting drug use — spinal infections are
  uncommon and they are missed because the pain looks ordinary. Fever plus
  back pain in this group is an emergency.
• Known abdominal aneurysm, or the risk factors for one — sudden severe
  back or flank pain with faintness is a 911 call, not a visit.

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What happens when you arrive here

• A physician sees you — board-certified, every visit, at every hour.
• An examination that is looking for the red flags specifically, including
  nerve function in the legs, rather than simply grading the pain.
• CT and X-ray on site if imaging would change the answer.
• Laboratory work in the building if infection is a possibility.
• Pain treated while you are here, whatever the cause turns out to be.
• Monitoring for up to 24 hours if you need watching rather than admitting.

If what you need is imaging we do not have here, a specialist opinion, or
admission, we stabilise you and arrange the transfer to a hospital. We are a
freestanding emergency room, not a hospital.

For back pain that matters more than usual, and it is worth being blunt about
what the visit is for: with a possible nerve-compression problem, our job is
to recognise it quickly and get you to the right place. That is a more useful
thing to know in advance than a list of on-site equipment.

What helps us most: when it started, what you were doing, whether anything
has changed about bladder, bowel or groin sensation, whether you can feel and
move both legs normally, and any cancer, steroid or blood-thinner history.

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What not to do

• Do not wait out numbness in the saddle area or a change in bladder
  control. That is the one pattern here where hours matter.
• Do not stay in bed for days. Gentle movement beats rest for ordinary back
  pain, even though it is counter-intuitive while it hurts.
• Do not take someone else's pain medication. If you have already taken
  something, tell us what and when.
• Do not push for a scan as reassurance. See above — for most back pain a
  scan does not reassure, it complicates.

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El Mirage ER — open 24 hours a day, 7 days a week, 365 days a year.
12000 N El Mirage Rd, El Mirage, AZ 85335 · (480) 237-4922
Walk in. No appointment, no referral.
If this is a medical emergency, call 911.

This article explains when to seek emergency care. It is not medical advice and
cannot account for your history, your medications, or what is happening to you
now. If you are unsure, call us or call 911.

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Sources

The guidance in this article about when to seek emergency care is drawn
from these public sources. Each one is linked so you can read it yourself.

• MedlinePlus (National Library of Medicine) — Back Pain — https://medlineplus.gov/backpain.html
• MedlinePlus Medical Encyclopedia — Abdominal aortic aneurysm — https://medlineplus.gov/ency/article/000162.htm
• MedlinePlus Medical Encyclopedia — Spinal cord abscess — https://medlineplus.gov/ency/article/001405.htm

This article is general information, not a diagnosis, and it cannot account
for your history or medications. If you are unsure, call us on (480) 237-4922
or come in. If it might be an emergency, treat it as one and call 911.

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