Brain & Nervous System Neurological Symptoms & Diagnosis Top 7 Most Serious Causes of Back Pain By Peter Pressman, MD Peter Pressman, MD, is a board-certified neurologist developing new ways to diagnose and care for people with neurocognitive disorders. Learn about our editorial process Peter Pressman, MD Medically reviewed by Medically reviewed by Claudia Chaves, MD on November 02, 2019 Claudia Chaves, MD, is board-certified in cerebrovascular disease and neurology with a subspecialty certification in vascular neurology. She is an associate professor of neurology at Tufts Medical School and medical director of the Lahey Clinic Multiple Sclerosis Center in Lexington, Massachusetts. Learn about our Medical Review Board Claudia Chaves, MD Updated on January 08, 2020 Print Approximately 80% of adults in the United States will suffer from back pain at some point. Fortunately, most of the time that pain is due to a straightforward problem such as a herniated disc or degenerative disease in the spine. These problems are bothersome, and can even be dangerous if too much time is allowed to pass, but they are not considered a medical emergency. On the other hand, anytime back pain is associated with weakness or loss of bladder or bowel control, it should be considered an emergency that requires immediate treatment. These symptoms can suggest compression of the spinal cord or cauda equina. Moreover, sometimes back pain can be a sign of more significant trouble. Here are some of the most serious causes of back pain that both doctors and patients must be careful not to miss. PeopleImages / Getty Images Osteomyelitis Osteomyelitis is an infection of the bone, usually due to invasive bacteria. The bacteria can be difficult for antibiotics to treat adequately, and a long course may be needed. In some cases, surgery may also be needed. Epidural Abscess An abscess is a collection of pus that results from a local infection. When this occurs in the epidural space in the meningeal tissues that surround the spine, it can lead to spinal cord compression, with sensory loss, weakness, and impaired bladder control. Fever may or may not be present. Primary or Metastatic Neoplasms Cancer can cause back pain in a number of different ways. A metastasis may lead to compression in the spine. Sometimes cancer can start in the spinal cord itself. Meningeal carcinomatosis can also cause back pain. Lyme Disease About 15 percent of people with Lyme disease develop neuroborreliosis when the bacteria invade the nervous system. Back pain is a common first symptom, then more nonspecific changes occur, such as numbness or more. It's important to mention, though, that chronic symptoms of Lyme disease are often over-diagnosed and treated with antibiotics despite there being very little evidence that such treatment is appropriate. Spinal Cord Infarction Strokes occur outside the brain as well and for all the same reasons. The spinal cord may have a vascular malformation, which could also predispose it to strokes. Guillain-Barré Syndrome Guillain-Barré is usually thought of as a problem with the nerve roots near the spinal cord, which is frequently painful in addition to causing weakness. Transverse Myelitis The exact causes of transverse myelitis are uncertain, though most doctors believe that it is autoimmune in nature, similar to multiple sclerosis. People with transverse myelitis develop inflammation in the spinal cord in a matter of weeks or hours. Symptoms can include pain, weakness, sensory changes, and bladder or bowel dysfunction. Referred Pain A good doctor knows that when someone comes in for back pain, a thorough examination should be done, including the abdomen and other areas of the body. This is because sometimes back pain results from a problem in another region of the body. This is known as referred pain. For example, either pancreatitis or an aortic dissection can spread to the back. Summary It's worth repeating that any time back pain is associated with new weakness or changes in bladder or bowel control, it's a sign that the nerves in the spinal cord may be seriously injured. Anyone with those symptoms should go to an emergency room immediately. It's important not to lose sight of the fact that these causes of back pain, however frightening, are relatively rare. Most of the millions of people across the world who suffer from back pain will not have any of these diseases. That said, because these diseases are so serious, it is important that patients and doctors remember not to overlook them. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. National Institute for Neurological Disorders and Stroke. Low back pain fact sheet. Updated August 13, 2019. Government of Alberta. Back pain, emergency or urgent symptoms: Care instructions. Updated September 23, 2018. Cleveland Clinic. Osteomyelitis. Updated November 28, 2017. MedlinePlus. Epidural abscess. Updated December 1, 2018. Johns Hopkins Medicine. Spinal cancer and spinal tumors. Halperin JJ. Chronic Lyme disease: misconceptions and challenges for patient management. Infect Drug Resist. 2015;8:119–128. doi:10.2147/IDR.S66739 National Institute of Neurological Disorders and Stroke. Spinal cord infarction information page. Updated March 27, 2019. National Institute of Neurological Disorders and Stroke. Guillain-Barré syndrome fact sheet. Updated August 13, 2019. National Institute of Neurological Disorders and Stroke. Transverse myelitis fact sheet. Updated August 13, 2019. Fields TR. An overview of lower back pain. Hospital for Special Surgery. Updated September 29, 2016. Additional Reading Ropper AH, Samuels MA, Klein J et al. Adams and Victor's Principles of Neurology 11th Edition. McGraw-Hill Education / Medical; 2019.