Acute Back Pain — When to Call a Doctor

Q: What's a red flag for back pain?

Loss of bladder/bowel control, saddle-area numbness, leg weakness, fever with back pain, new severe pain after age 50, pain after trauma, history of cancer — call a doctor or 112 immediately.

Reading time: 5 minutesUpdated April 2026

Sudden low back pain (Hexenschuss) is one of the most common reasons for emergency medical contact. Most cases are benign and resolve within days — but some need urgent assessment.

First measures at home

Stay moderately active — complete bed rest delays recovery
Heat (hot pack, warm bath) for muscle spasm
Paracetamol 1 g up to 4×/day; ibuprofen 400 mg up to 3×/day (if tolerated)
Avoid heavy lifting and twisting
Use pillows to support the spine when lying down

Red flags — call a doctor today

Loss of bladder or bowel control (possible cauda equina — emergency)
Numbness in the saddle area (inner thighs, genitals)
New leg weakness, foot drop
Fever with back pain (possible spinal infection)
Severe pain after significant trauma
New severe back pain after age 50 or with history of cancer
Pain at night, waking you up, or constant and unrelieved by rest
Unexplained weight loss with back pain

Call 112 for cauda equina symptoms:

Sudden loss of bladder or bowel control
Numbness in saddle area with leg weakness

What the doctor can do at home

Neurological examination (reflexes, sensation, muscle strength)
Palpation of the lumbar spine and paraspinal muscles
Provisional diagnosis: muscular strain, lumbago, sciatica, disc herniation
Intramuscular injection of analgesic/muscle relaxant where appropriate
Infiltration near trigger points (local anaesthetic)
IV infusion for severe pain (e.g. Novalgin, with patient consent)
Private prescription for stronger analgesics where needed
Sick note
Referral to orthopaedic specialist or emergency department if red flags present

FAQ

What's a red flag for back pain?

Bladder/bowel control loss, saddle numbness, leg weakness, fever, severe post-trauma pain, or new pain after 50 with cancer history.

Can you give an injection at home?

Yes. Intramuscular analgesic/muscle relaxant injections are a standard on-site treatment for acute lumbago.

Cost?

per GOÄ, from 180 € (cost depends on time of day, day of week, and services rendered). Private insurance usually reimburses fully.

General information only. In emergencies (cauda equina, severe trauma) call 112.

Sources: AWMF NVL Kreuzschmerz, DEGAM guidelines.