Seven signs that do not wait for an appointment

• You have lost control of your bladder or bowel, or you have new numbness in the area you would sit on. This combination points to the bundle of nerves at the bottom of the spinal canal being squeezed. The window to reverse it before the damage is permanent is measured in hours, not days.
• A limb is getting weaker, not just more painful, and it is changing by the day or the hour. Pain that stays the same is one thing. Strength that is actively dropping is a nerve being damaged in real time.
• You have a fever along with new or worsening back or neck pain. An infection in or around the spine is rare. But it is dangerous enough that the combination gets ruled out right away rather than watched.
• Severe pain started right after a fall, a car crash, or another significant impact. The concern is a fracture or an unstable spine that has not been imaged yet. Moving around on an unstable spine before that is checked carries real risk.
• You have a history of cancer and new pain that does not fit your usual pattern. Bone is a common place for cancer that has spread (metastatic disease) to show up first as pain. That possibility gets checked, not assumed away.
• A limb has become swollen, discolored, unusually sensitive to touch, or a different temperature than the rest of you after a minor injury, and it is getting worse quickly. This pattern can be the early, fast-moving phase of a nerve-driven pain syndrome. Early treatment changes the outcome. Complex regional pain syndrome.
• Pain that feels like it is coming from your back is paired with chest pressure, shortness of breath, or abdominal pain. The spine is not the only part that can send pain into the back. A handful of the causes that do — heart, blood vessel, belly — are not ones any pain clinic should be managing as an office visit.

What this practice is for instead

Almost everything else is exactly what this practice is built to work through. That means pain that has been building for weeks or years. It means pain after an injury that has already been checked and cleared of the items above. It means pain that comes and goes with activity, or pain that has outlasted physical therapy or medication. That work happens on a schedule, with a history and an exam before any procedure, because the diagnosis matters as much as the treatment. What to expect at the first visit.

Maybe you went to the emergency department for one of the seven signs above. Maybe you were sent home with a clearer picture but no lasting plan. That is a normal, expected handoff, not a dead end. Bring the discharge papers to your first visit here, and we will pick up the thread from there.

Common questions

Related reading

• What to expect at the first visit
• Complex regional pain syndrome
• After a car accident
• Compression fracture
• Contact