The Dangers Behind Lower Back Pain and Fever

Lower back pain is the most common reason stated for work-related absences. This type of pain will often have pronounced impact on overall performance and motivation. But because an achy back caused by occupational factors can often be resolved with a little rest, we tend to brush it off as a trivial problem.

But did you know that some cases of backache might require much more than a rest day? Those that come hand in hand with other symptoms of illness can be indicative of something far worse than just a typical case of a bad back. For instance, a fever coupled with back pain can spell a world’s worth of different conditions. Some of these might be easily remedied with medication and rest. Others could lead to potentially life-threatening complications in the long run.

If you’ve been having bouts of lower back pain that comes hand in hand with heightened body temperature, it might be time to act. Read on through to find out just what these symptoms might mean.

Of course, as always note that the information in this article is purely informative and should never be used in place of the advice of your treating physicians.

Understanding Pain and Pyrexia

Pain and pyrexia (fever) are the body’s way of alerting the individual that there is an on-going threat to one’s overall health and wellness. That’s why you’ll often notice that both pain and heightened body temperature occur at the onset of illness, signaling the beginning of the problem.

Commonly, a fever occurs in the presence of an infection. Because some forms of bacteria can’t survive high temperatures, our bodies bump up the heat to help our immune system kill off what colonies of bacteria that it can.

When is it Time to Visit the Doctor?

According to statistics, only a small fraction of individuals will seek medical attention immediately after they experience symptoms of illness. This is especially true when they believe that their symptoms aren’t indicative of anything serious. Most people consider lower back pain and fever low urgency symptoms, so not everyone will visit a doctor to get a diagnosis.

In many cases, while it may be okay to manage these two problems from the comfort of home, here are some scenarios when you should consider visiting your doctor:

  • Persistent, increasing lower back pain that doesn’t resolve with over-the-counter pain medications (ibuprofen, Tylenol, etc.)
  • Numbness and or tingling, especially in the lower extremities.
  • Radiating pain into the legs that (i.e. sciatica)
  • Leg weakness
  • Recurrent fevers that subside and return several times in a day
  • Loss of bowel and bladder control
  • Inability to feel yourself wipe after toileting

There are a numerous conditions that are characterized by fevers and back pain. Some are more common than others.

Kidney Infection

Pyelonephritis (or a kidney infection) is one of the most common causes of simultaneous back pain and fever.

A kidney infection is commonly the result of an unresolved urinary tract infection (UTI). When a UTI is not appropriately treated, the bacteria that cause it can travel further up through the ureter and infect the kidneys. This is referred to as pyelonephritis. Early signs of pyelonephritis include fever and back pain.

While the reason for the fever is self-explanatory, it may be confusing as to why a kidney infection would cause back pain. As a result of how our nervous system is wired, kidney pain refers pain to the back. Consequently, as most back pain is related to irritation of the muscles and ligaments in the back, it is important to keep pyelonephritis in mind as an uncommon cause of low back pain.

Pharmacotherapy (typically with antibiotics) at the first signs of pyelonephritis can help prevent further complications. It is important to recognize this potentially very serious condition and seek immediate medical attention.


Osteomyelitis is an infection of bone. This can occur anywhere in the body. When it occurs within the bones of the spine this can lead to low back pain and fever.  The most common causes of osteomyelitis of the spine are previous spinal surgery and from the spread of infection from another part of the body (from septicemia). 

According to statistics, the chances of contracting an infection of the spine after spine surgery are not high. In most cases, a prompt dose of antibiotics should be more than enough to resolve the infection. However, more pronounced infections could require the reopening of surgical wound to remove infected tissue and wash out the wound.

Septicemia, or bacteria in the blood, can lead to a spinal infection as well. This can occur after a procedure: colonoscopy, cystoscopy, dental cleaning, or any other procedure that requires the introduction of a foreign object into the body. These procedures can lead to a temporary release of bacteria into the blood. The bacteria that can travel to healthy tissues of the body, including the spine, leading to infection.  However, this latter scenario is quite uncommon, and usually only occurs if an individual has a weak immune system to begin with. In fact, much more commonly it occurs with illicit intravenous drug use.

Pharmacotherapy (typically with antibiotics) at the first signs of osteomyelitis can help prevent further complications. It is important to recognize this potentially very serious condition and seek immediate medical attention.

Muscle Injury, Damage, and Death

Individuals who overwork the muscles can be particularly prone to a condition called rhabdomyolysis. This is characterized by the death of muscle tissue usually as the result of very strenuous activity.

The muscles of the back are some of the most utilized muscles in the body. Simple activities like standing, sitting, walking, and other, seemingly mundane postural actions all require the engagement of the lower back muscles. Combine this with demanding activities like heavy lifting and muscle injury and subsequent damage are certainly a risk.

Individuals who are most at risk of this type of overworking the back muscles are athletes and manual laborers who are consistently pushing their muscles to their limits.

If the muscles are overworked, not only can this lead to back pain and even fevers, but the tissues can die and breakdown, resulting in a release of toxins throughout the system. These toxins and muscle break-down products then enter the bloodstream which can significantly burden the kidneys. This can lead to kidney damage and in severe cases, potentially even kidney failure,

Treatment of rhabdomylosis depends on the severity of the case.  In minor cases, the condition can be addressed with rest and fluid intake to help normalize the blood chemistry. In severe cases that lead to kidney damage, however, hospitalization may be necessary.


Lower back pain and fever are oftentimes overlooked when they occur in isolation.  In most cases, this is okay. However, if you are experiencing both low back pain and fever at the same time that is not resolving, you should seek medical attention, as this can indicate a more serious underlying condition.

Of course, as always note that the information in this article is purely informative and should never be used in place of the advice of your treating physicians.

Dr. Andrew Chung
Dr. Andrew Chung

Dr. Andrew Chung is a Spine Surgeon at Sonoran Spine in Tempe, Arizona. He is a graduate of the Philadelphia College of Osteopathic Medicine and was formerly Spine Surgeon Clinical Fellow at Cedars-Sinai, Spine Surgery Fellow at Keck Hospital, University of Southern California and Chief Resident and an Instructor of Orthopedic Surgery in the Department of Orthopedic Surgery at the Mayo Clinic in Arizona. Dr. Chung's research.