“There are only a few guarantees in life: Death, taxes and back pain,” neurosurgeon Dr. Ryan Hofler of Novant Health Brain & Spine Surgery - Huntersville likes to say. “Everybody’s got a spine, and everybody, at some point in their lifetime, is likely to have a problem with their spine — whether temporary or more serious.”

If you’re in unbearable pain, going to the emergency room is instinctual. But if you’re lower on the pain scale, it can be tricky to decide if you need medical attention.

These five questions can guide you with back pain:

• Where’s the pain?
• What caused it?
• How long have you felt it?
• Is it getting better or worse?
• Does it improve when you treat it at home?

And if something isn’t right, getting it looked at sooner than later may spare you a lot of misery and get the problem solved before more intensive treatment is needed, as Hofler explains below.

What back pain can you treat at home?

Soreness and discomfort, from an obvious cause, that improves with rest

When you exercise or perform manual labor, you overwork and tear tiny fibers in your muscles — then your body repairs them and builds the muscles back stronger. It’s normal to have a tight, achy or tender feeling in the areas you worked, especially if you perform the activity again.

It’s also normal to sometimes feel discomfort or mild back pain without exercising — like if you sit for a long road trip or fall asleep in an uncomfortable position.

When at-home care for back pain is enough

If your discomfort improves with rest, doesn’t get worse, gets better with relief measures (detailed below), and you feel back to normal within 1-2 weeks, you likely don’t need further medical attention.

Here’s what can help back pain at home:

• Try gentle stretches — this list is a good starting point.
• Stay active — instead of putting yourself on bed rest, take short walks and rest from the activity or position that aggravated your discomfort.
• Use a heating pad or ice pack for 15 to 30 minutes.
• Take an over-the-counter medication like acetaminophen or ibuprofen, being careful to follow dosing directions.
• Use a massage gun if you have one, or get a massage.

When to seek treatment for back pain

Pain that gets worse, moves into other areas, or doesn’t respond to medication

Pain in itself is a warning light: “People aren't supposed to be in pain,” Hofler said. “Pain is a sign something is wrong.”

Call your primary care doctor if your back pain is getting progressively worse, has lasted more than 1-2 weeks, or doesn’t respond to over-the-counter medication.

Make a same-day appointment with your doctor if you feel numbness, a pins-and-needles sensation, or if your back pain is expanding to new areas (like pain radiating down the leg).

Go to the emergency room if you have back pain with:

• Loss of bladder or bowel functioning
• Sudden weakness — for example, yesterday you could walk but today you can’t move your foot
• Numbness in the “saddle region” — your groin, bottom and inner thigh

What your doctor may recommend for back pain

If at-home measures haven’t helped, doctors usually recommend back pain treatments like:

• Physical therapy
• A prescription dose of a non-steroidal anti-inflammatory drug
• An oral steroid
• Muscle relaxers
• Gabapentin, a medication for nerve pain
• A steroid injection
• A nerve block

Most of the time, people find relief with one of these options — or a combination of these options.

If you don’t, your doctor will refer you for additional imaging and evaluation.

Surgery is typically performed only when other options have failed. And just because you’re referred to a surgeon doesn’t mean they’ll recommend an operation. In most cases, they’ll start with conservative options and go from there. However, if you're rapidly losing functioning, surgery may be required sooner.

Why waiting it out isn’t a good idea

It may feel tempting to see if your pain heals on its own. Maybe you can’t take time off work, don’t have childcare or family care, or are worried about your finances.

But if you delay care, the problem can last longer — even after care is received — and treatment may be more involved, more costly and less successful, Hofler said.

What happens when you put off care for back pain

Degeneration and aging make things worse

Your spine is already susceptible to damage over time — called “degeneration” — due to aging. On top of that, everyday activities can increase your risk for spine injury.

If pain from degeneration or injury isn’t treated early, the condition can worsen — making treatment more complex and recovery slower.

Additionally, as you get older, your body's capacity for healing decreases and you heal more slowly than you did when you were younger.

“If you have a disc herniation in your 30s and have it addressed quickly, it will heal pretty quickly,” Hofler said. “But if you’re in your 70s, it may take longer for it to heal, and it may not heal as completely simply due to your age. If you get treated early in the pain process, you’ll have less healing to go, and you’ve got a much better chance of improvement.”

The cycle of pain

People in pain often move less, which decreases their strength and worsens pain. “Pain becomes a vicious cycle — the longer you're in pain, the harder it becomes to get you out of pain,” Hofler said.

Nerve damage

If a person receives treatment within the first few weeks of experiencing a herniated disc, their pain may go away within a few months with physical therapy, medication or a steroid injection.

Even if this patient ends up needing surgery, “the vast majority of these people wake up feeling better after surgery — their pain is gone and their weakness and numbness improve pretty quickly,” Hofler said.

But if the disc has been pressing on nearby nerve endings for a few years, that nerve has been damaged. Nerves can heal — but slowly, and they don’t heal completely.

If you get a deep cut and your skin heals around it, you develop a scar — it isn’t exactly the same as it was before. Similarly, when nerve fibers get damaged and replaced by scar tissue, the nerves may never be the same as they were before.

“We might be able to get the pressure off your nerve with surgery, but we may not see as strong a response to the improvement in pain, numbness and weakness,” Hofler said.

How early help for back pain made a difference

A few years ago, Hofler was vacationing with his wife in Italy and climbed up the 463 steps of the Cathedral of Santa Maria del Fiore, a famous cathedral in Florence.

The next day, he woke up to a nasty surprise: Radiating leg pain. Ibuprofen didn’t put a dent in it.

By the time he got home, his foot was numb and his foot muscles were starting to get weak. An MRI revealed a herniated disc.

After a muscle relaxer, a steroid pack and physical therapy didn’t provide enough relief, Hofler received a steroid injection.

“Within a week, the pain was gone, my foot strength was back to normal, and about a month later the numbness was pretty much all gone,” Hofler said.

Because he got help early, Hofler was able to avoid surgery.

“Early action really saved me a lot of long-term issues and kept me out of the operating room — so I could get back into the operating room!”

The takeaway: Don’t ignore pain.

If you have new pain that isn’t going away, is getting worse and isn’t responding to at-home treatments, don’t ignore it.

“Letting it be and letting it fester can make things worse in the long run,” Hofler said. “Putting off care can make treating it more difficult, more invasive and a lot harder to be successful.”

If your pain isn’t better after two weeks, talk to your primary care clinician.

“It’s always worth having it looked at if it's not getting better, because there may be a simple fix,” Hofler said.