Is My Pain Serious?

How do you know whether your pain needs to be evaluated by your chiropractor? This is the age-old question. The answer needs to be specific to your particular problem, rather than a one-size-fits all solution. But there are good guidelines that everyone can follow.
First, is your pain deep and boring (that is, does the pain feel like it's boring into you)? Deep and boring pain usually means something is seriously wrong. If you're woken up at night by this type of pain, a visit to your chiropractor or family physician is in order. Kidney stones and inflamed gallbladders are common causes for deep, boring pain that causes a person to awaken from sleep. Severe heartburn is in this category, too, and should be evaluated by your doctor.
But these types of problems are easy to categorize. You'll probably know, instinctively, that something is wrong. Musculoskeletal pain is rather more difficult to analyze. For example, you lean over in a twisting motion to grab the glass of water on your nightstand and you feel a sharp pain in your lower back. Next morning you have great difficulty getting out of bed. Your lower back is stiff and sore. What should you do?1,2
Your best course of action will be based on a self-assessment. If you're experiencing pain that radiates down your leg, or numbness or tingling sensations traveling down your leg, you should call your chiropractor's office and ask to be seen right away. Or, if you don't have any radiating pain, but sneezing or coughing does provoke a radiating sensation, take the same action. Similarly, the amount of pain you're having will determine what you do. If the pain is severe, see your chiropractor.
If none of these criteria are present, decision-making gets a bit murky. How you handle your problem will depend on your tolerance for pain. If you have low tolerance, make an appointment to see your chiropractor and get some expert treatment. If you have a higher pain threshold, you might still call for an appointment just to make sure that nothing is seriously wrong. Certainly, if you haven't improved at all after 48 hours, you need to see your chiropractor.
There is another important scenario. If you have a medical condition such as cancer, an endocrine disorder, or a systemic infection, a sudden occurrence of back pain needs immediate attention, regardless of how or why you think the pain occurred.3 This is not to be an alarmist, but rather the recommendation is based on precaution. If there is an existing problem, then new issues need to be looked at closely, just to be sure.
These guidelines provide a sound basis for decision-making, but please remember they are just that - guidelines. Each person needs to be comfortable with their own process. And, of course, it's always much better to be safe than sorry. Your chiropractor is always available to help you sort out these kinds of problems.
1Smart KM, et al: The discriminative validity of "nociceptive," "peripheral neuropathic," and "central sensitization" as mechanisms-based classifications of musculoskeletal pain. Clin J Pain 27(8):655-653, 2011
2Arendt-Nielsen L, Graven-Nielsen T: Translational musculoskeletal pain research. Clin Rheumatol 25(2):209-226, 2011
3Casazza BA: Diagnosis and treatment of acute low back pain. Am Fam Physician 85(4):343-350, 2012

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