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Is My Back or Neck Pain Serious? Warning Signs to Know

By Mr Ahmed-Ramadan Sadek, Neurosurgeon · 6 min read

Key points

  • Most back and neck pain is not caused by anything serious and gets better within a few weeks.
  • A small number of symptoms, called red flags, can point to a problem that needs checking quickly.
  • This page groups those warning signs by urgency: call 999 now, get help today, or see your GP within days.
  • One warning sign on its own does not mean something serious is wrong, but a doctor should check you.
  • If you are not sure how urgent it is, call NHS 111.

Call 999 or go to A&E now if you have back pain with:

  • Numbness, tingling or altered feeling around your bottom, genitals or inner thighs (the area you would sit on in a saddle).
  • New trouble passing urine, a weak or unfelt flow, not knowing when your bladder is full, or new leaking of urine.
  • New loss of bowel control, or not being able to feel when you need to open your bowels.
  • New changes in sexual feeling, or new difficulty getting an erection or ejaculating.
  • Pain, tingling, numbness or weakness in both legs, or leg weakness that is getting worse quickly.
  • Sudden, severe weakness in your arms or legs, sudden clumsiness, or new difficulty walking.
  • Severe back or neck pain after a serious accident, such as a car crash or a fall from a height.
  • Chest pain as well as back pain.

The first five can be signs of cauda equina syndrome, where the nerves at the bottom of the spine are squeezed. It is rare, but it is an emergency. Do not wait for a routine appointment, and do not drive yourself: ask someone to take you or call an ambulance.[1][7]

Why these symptoms matter

The nerves at the base of the spine control your bladder, bowel and sexual function as well as your legs, and damage can become permanent if pressure on them is not relieved quickly. The national NHS pathway describes cauda equina syndrome as very rare (about 1 to 3 in 100,000 people), but asks for an emergency MRI scan when these symptoms are new or worsening within the last two weeks.[7] No single symptom proves or rules it out, which is why doctors would much rather see you early.[7]

If you have pain, tingling, numbness or weakness in both legs, follow NHS advice: go to A&E or call 999 straight away.[1] See also our guide to sciatica.

Get help the same day (urgent GP appointment, NHS 111, or A&E if they advise) if you have:

  • Neck pain with hand or walking problems: clumsy hands, dropping things, trouble with buttons or writing, feeling unsteady on your feet, or electric shock feelings down your back or into your arms when you bend your neck.
  • Weakness that is slowly getting worse, or a feeling of heaviness, in your arms or legs.
  • Back pain with a high temperature, shivers, or feeling generally very unwell.
  • New back or neck pain and a history of cancer, whether the cancer is current or was treated in the past.
  • Sudden severe back pain after a fall, a lift or even a small strain, especially if you have thin bones (osteoporosis), have taken steroid tablets for a long time, or are older.
  • Severe pain that started suddenly or is getting worse quickly.

If any of these come with numbness in the saddle area, bladder or bowel changes, or weakness in both legs, treat it as a 999 emergency instead.

Pressure on the spinal cord in the neck

Wear and tear in the neck can slowly narrow the space around the spinal cord. This is called degenerative cervical myelopathy. Early signs are often subtle, such as numb or clumsy hands, poor balance and falls, and it is most often found in people over 50.[8] The NHS advises an urgent GP appointment or NHS 111 for heaviness or weakness in the arms or legs, and 999 for new walking problems, loss of bladder or bowel control, or sudden loss of co-ordination.[2] See our guide to cervical myelopathy.

Possible spinal infection

Spinal infection is uncommon, but more likely with diabetes, a weakened immune system (for example from chemotherapy, HIV or immune-suppressing medicines), a recent infection elsewhere, or injecting drug use.[5] Recent surgery also raises the risk of bone infection,[3] so tell the doctor if you have had an operation or procedure on your spine recently. Feeling hot, cold or shivery with back pain is a reason to get urgent advice.[1]

If you have, or have had, cancer

Some cancers can spread to the spine. In anyone with past or current cancer, NICE says to take seriously back pain that is severe and constant, steadily worsening, worse on coughing or straining, or disturbing sleep. If this pain comes with weakness, numbness, difficulty walking, or bladder or bowel problems, NICE says it should be treated as an emergency and discussed with the specialist team straight away; pain alone should be discussed within 24 hours.[6]

If you have a cancer diagnosis: if your cancer team has given you a number to call for new back or neck symptoms, call it straight away. Otherwise, get urgent medical help the same day through your GP or NHS 111. If you also have weakness, numbness, walking problems or bladder or bowel changes, go to A&E or call 999.[6]

Possible fracture

A spinal bone can break after a big injury or, if your bones are thin, after a minor fall or heavy lift.[5] A research review found older age, long-term steroid tablets and severe injury were among the more useful clues, and several clues together were more telling than one.[9] Pain that comes on suddenly in the middle of the back and eases when you lie down is typical.[5] Our guide to spinal compression fractures and vertebroplasty explains more.

See your GP soon (within a few days) if you have back or neck pain and:

  • You have lost weight without trying.
  • The pain is constant, does not ease with rest or changing position, or is worse at night and wakes you.
  • It is worse when you cough, sneeze or open your bowels.
  • The pain is in the upper back, between the shoulder blades, rather than the lower back.
  • There is a lump or swelling in your back, or its shape has changed.
  • It is not improving after a few weeks of looking after it at home, or it is stopping you doing everyday things.

These usually turn out not to be serious, but your GP can decide whether you need tests.

Sources draw these lines in slightly different places. The NHS suggests seeing a GP if pain has not improved after a few weeks,[1] while NICE Clinical Knowledge Summaries list no improvement after 4 to 6 weeks of treatment among possible signs of cancer.[5] The research review found that most single warning signs are weak clues on their own, so doctors look at the whole picture.[9] NICE back pain guidance covers people over 16.[4]

Most back pain is not serious

Back pain is very common. It usually comes from muscles, joints or discs and gets better within a few weeks.[1] Serious causes such as cancer, infection or a fracture are uncommon,[1][5] and NICE asks doctors to think about them when assessing anyone with back pain, particularly if new or different symptoms appear.[4]

It is normal for back pain to be very sore for a few days, to come and go, and to feel stiff in the morning. Staying active, taking simple anti-inflammatory painkillers if they are suitable for you, and using heat or cold can all help.[1] Our guide to acute back pain has practical tips.

What to say when you call
Say exactly what you have noticed and when it started, for example numbness when wiping after the toilet. If you have saddle numbness or bladder, bowel or sexual changes, say clearly: “I am worried about cauda equina syndrome.” Mention any cancer (past or present), recent spine operation or injection, fever, and medicines, especially steroids. Bring your medicines with you if you go to hospital.[1][6][7]

Printable warning-signs card

A one-page card listing these warning signs is available to print and keep at home or with your medicines.

Download the warning-signs card (PDF)

Further reading

References

  1. NHS. Back pain. NHS website. Page last reviewed 5 March 2026. Link
  2. NHS. Cervical spondylosis. NHS website. Page last reviewed 2 August 2023. Link
  3. NHS. Osteomyelitis. NHS website. Page last reviewed 16 August 2023. Link
  4. National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management (NG59). Published 30 November 2016, last updated 29 July 2026. Link
  5. NICE Clinical Knowledge Summaries. Back pain, low (without radiculopathy): assessment and red flags. Last revised August 2026. Link
  6. National Institute for Health and Care Excellence. Spinal metastases and metastatic spinal cord compression (NG234). Published 6 September 2023. Link
  7. Getting It Right First Time (GIRFT), NHS England. Spinal Surgery: National Suspected Cauda Equina Syndrome (CES) Pathway. February 2023, updated March 2026. Link
  8. Davies BM, Mowforth OD, Smith EK, Kotter MR. Degenerative cervical myelopathy. BMJ. 2018;360:k186. Link
  9. Downie A, Williams CM, Henschke N, et al. Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ. 2013;347:f7095. Link

This page gives general information only and is not a substitute for advice about your own situation. If you are worried about your symptoms, contact your GP, call NHS 111, or in an emergency call 999.

This page gives general information only and is not a substitute for advice about your own situation. If you are worried about your symptoms, contact your GP, call NHS 111, or in an emergency call 999.

Last checked: October 2026