Back Pain: When Is It a Nerve Problem and When to See a Neurologist?

Back pain is one of the most common complaints in India — nearly 80% of people will have a significant episode at some point in their lives. Most back pain resolves with simple measures. But when it travels down the leg, causes numbness, or is accompanied by weakness — that changes everything.

Simple Back Pain vs Nerve-Related Back Pain

Simple (mechanical) back pain: Localised to the back, no radiation beyond the knee, no numbness or weakness. Usually muscular or ligamentous in origin. Gets better with rest, physiotherapy, and anti-inflammatories within 4–6 weeks in most cases.

Radicular pain (nerve compression): Pain radiates from the back down one leg (typically following a specific path — e.g. outer thigh, down the shin, to the big toe for L4/L5). Often described as burning, shooting, or electric. May be accompanied by numbness, tingling, or weakness in the leg or foot. This is caused by compression of a nerve root — most commonly from a disc prolapse.

When to See a Neurologist for Back Pain

• Pain shooting down the leg past the knee (sciatica)
• Numbness or tingling in the leg or foot
• Weakness in the leg — foot drop (cannot lift the foot), or difficulty rising from a chair
• Back pain that does not improve after 6 weeks of conservative treatment
• Bladder or bowel problems with back pain — this is a red flag needing emergency evaluation (could be cauda equina syndrome)
• Back pain with fever, weight loss, or in a person with cancer history

Diagnosis

MRI of the lumbar spine (or cervical spine if the pain is in the neck with arm radiation) is the key investigation. Nerve conduction studies and EMG may be done to assess the severity of nerve damage and guide prognosis.

Treatment

• Conservative: Physiotherapy, pain management, nerve pain medications (pregabalin, duloxetine), activity modification
• Epidural steroid injections: Effective for acute, severe radicular pain
• Surgery: For disc prolapse causing progressive weakness, severe uncontrolled pain, or bladder/bowel symptoms — microdiscectomy is a well-established procedure with good outcomes

"Most disc prolapses get better with time and conservative treatment. But foot drop or bladder symptoms with back pain are surgical emergencies — do not wait."

Dr. Anand Karnam evaluates nerve-related back pain and spine conditions at Sri Anand Child and Neuro Center, Chanda Nagar. Call +91 90633 66983.