Lower Back Pain - Red Flags

In the medical word, the term "red flag" means a clinical indicator, a sign or symptom, that warrants further investigation. The intent is not to miss a serious underlying condition. The term was first used in the 1980's in the evaluation of lower back pain patients (Ref). There are red flags that are general and have many possible causes (e.g. unexplained weight loss) or it may be more specific (e.g. lower back pain with loss of bladder function).

When evaluating lower back pain, red flags (Ref) (Ref) (Ref) include

• Recent trauma, especially in people older than age 50

• Previous history of cancer

• Recent bacterial infection

• Loss of bladder function

• Loss of bowel function

• Pain that awakens you at night

• Pain that lasts more than 6 weeks

• Pain in persons younger than 18 years

• Pain in persons older than 50 years

• Unexplained weight loss

• Fever (persistent) and chills

• Night sweats

• History of intravenous drug use

• Lower back surgery within the last year

• Saddle anesthesia (loss of sensation in your buttocks)

• Prolonged use of corticosteriods

• Pain that radiates below the knee

• A significant loss of lower extremity strength

Any one of these red flags requires a careful examination to rule out potentially serious conditions.

References:

Red Flags for Low Back Pain Are Not Always Really Red

Evaluation of red flags minimizes missing serious diseases in primary care

Acute Low Back Pain: Recognizing the "Red Flags" in the Work-up