​Back pain is extremely common — about 90% of people experience it at some point in their lives. Dr Colum Nolan, Head of Neurosurgery, Sengkang General Hospital, and Consultant, Department of Neurosurgery, NNI, explains when we should be concerned, and where to seek medical help.


A pulled back muscle (lumbar strain) is the most common cause of back pain. A warm or cold compress and pain medication can provide relief, and it usually gets better on its own within one to two weeks. "Bed rest is not best when it comes to back pain, so continue to stay active unless otherwise advised by your doctor," says Dr Colum. However, about one in 10 cases of back pain needs medical attention. So when should you see a primary care doctor, a specialist, or go straight to the Emergency Department?

Back Pain 'Red Flags'

These symptoms with back pain are warning signs that specialist or emergency treatment may be needed:

  • Unexplained weight loss
  • Loss of appetite
  • Neurologic symptoms; e.g., numbness, weakness in legs
  • Older age (above 50 years old)
  • Fever
  • History of cancer
  • Problems passing urine or bowel motions
  • Back pain caused by an accident or trauma 


If your back pain is not getting better or if you are worried about it, see a primary care doctor (general practitioner or polyclinic doctor). Your doctor will assess your condition and check for ‘red flags’ (see above), which may require referral to the Emergency Department or an urgent referral to a spine specialist.

If there are no red flags associated with the back pain, your doctor can usually treat it with medication and/or refer you for physiotherapy. Your doctor may refer you to a spine specialist if your symptoms worsen, persist beyond six weeks, or if you begin to experience neurological problems.


Back pain with one or more ‘red flags’ should be seen in the Emergency Department or urgently in the Specialist Outpatient Clinic (SOC) by a spine specialist (either a neurosurgeon or an orthopaedic surgeon trained in the management of spinal disorders), depending on the urgency. Most referrals to the SOC are less urgent, with two of the most common reasons for referral to our clinic being:

Slipped disc

  • Discs act as cushions between bones in the spine
  • When a disc slips or bulges out, it can press on nerves, causing back pain with sciatica
  • Sciatica is lower back pain that spreads to the hip, buttocks and legs
  • Can affect adults of all ages
  • Treated with medications and physiotherapy (if no weakness or red flags); if symptoms do not improve after six to eight weeks, steroid injections or surgery may be considered

Spinal stenosis

  • Narrowing of spaces within the spine, which can put pressure on nerves
  • Caused by wear and tear in the spine
  • Usually affects people aged 60 years and older
  • Common symptoms:
    • Back and leg pain when walking that is relieved by rest
    • Heaviness, weakness or numbness, often in both legs
    • Treated with medication, physiotherapy, steroid injections or surgery, depending on severity of symptoms

Other back conditions treated by spine specialists include scoliosis (curvature of the spine), spondylosis (arthritis in the spine), spine tumours, fractures and infections.


Some back conditions require urgent medical attention. Go to the Emergency Department if you have:

  • Suffered a severe trauma to your back from
    • a road accident
    • a fall from height
    • a sports injury; e.g., from trampolining, rock climbing, etc.
  • Back pain with weakness in the legs or loss of bowel or bladder control

This article first appeared in NeusLink Issue 14 - click to download!

Check out another related article:

Sciatica: Back Pain That Can Extend Down to the Feet