Will Back Pain Turn to Paralysis if it Goes Untreated?

Common misconceptions about back pain and misleading information especially online can lead to confusion. One myth that has been brought to my attention recently, is that untreated back pain can get worse and eventually lead to paralysis.

There are two suppositions that underlie this statement. The first is that treatment always means surgery. Treatment for back pain can have a variety of forms. It doesn’t necessarily mean an operation. Conservative care including rest, exercise, medications, and physical therapy is the mainstay of treatment. Unless there is a neurological issue (problem), I will initially steer my patients towards a non-invasive approach. As a matter of fact, the vast majority of back pain patients are treated medically and not surgically.

The second supposition is that all back pain leads to a neurologic consequence. This is not true. Actually, most chronic back pain patients are not surgical and their disease does not threaten the neurological structures of the spine. With the right treatment plan, we can mitigate most of their back pain. Hopefully, this can be done without significant use of chronic narcotics.

However, new and unexplained back pain should be checked out immediately. There is a chance this new pain could be caused by a more serious and surgical pathology that if left untreated, could lead to serious medical consequences. Back pain runs the spectrum from completely benign (pain that can be fixed with medical treatment and does not have serious neurological risks) to more dangerous lesions that can threaten neurological function and need surgery. Each case needs to be individually evaluated to structure the appropriate work-up and treatment plan.

Take two different people:

· A 60-year-old women with breast cancer who develops sudden back pain and never had it before

· A 32-year-old overweight man who has had back pain for many years

Between these two cases, I am much more concerned about the older woman than I am of the younger man. The 32-year-old will probably need just x-rays and then be managed conservatively with behavior modification, weight loss, physical therapy, and an exercise plan. He does not have a high risk for needing surgery. The 60-year-old woman’s medical history and current condition indicates she may have something more serious such as a metastatic tumor. She may actually be at risk for paralysis. She would need to have multiple scans, see multiple specialists, and possibly have surgery.

There are so many layers to back pain that there’s no blanket statement to cover all scenarios. The best advice I can give is to see your physician for any new and unexplained back pain so it can be evaluated. If you have chronic lower back pain, you should also see a physician so a proper comprehensive treatment plan can be created for you. Only very specific types of back pain lead to paralysis and these pathologies are the minority of cases of back pain. It’s best for a physician to make the judgment call regarding the type of pain you may have.