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Low Back Pain Red FlagAka: Serious Low Back Symptoms, Low Back Pain suggestive of Spinal Fracture, Low Back Pain Suggestive of Cancer, Low Back Pain Suggestive of Infection, Low Back Pain Suggestive of Neurologic Injury

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1. Low Back Pain
Red Flags: Cancer Related Red Flags with Low Back Pain
1. History of cancer
2. Unexplained weight loss >10 kg within 6 months
3. Age over 50 years or under 17 years old
4. Failure to improve with therapy
5. Pain persists for more than 4 to 6 weeks
6. Night pain or pain at rest
Red Flags: Infection Related Red Flags with Low Back Pain
1. Persistent fever (temperature over 100.4 F)
2. History of intravenous Drug Abuse
3. Recent bacterial infection
4. Immunocompromised states
  1. Systemic Corticosteroids
  2. Organ transplant
  3. Diabetes Mellitus
  4. Human Immunodeficiency Virus (HIV)
  5. Rest Pain
Red Flags: Cauda Equina Syndrome Related Red Flags with Back Pain
1. Urinary Incontinence or retention
2. Saddle anesthesia
3. Anal sphincter tone decreased or fecal Incontinence
4. Bilateral lower extremity weakness or numbness
5. Progressive neurologic deficit
Red Flags: Significant Herniated nucleus pulposus
1. Major Muscle Weakness (strength 3 of 5 or less)
2. Foot drop
Red Flags: Vertebral Fracture related red flags with Low Back Pain
1. Prolonged use of Corticosteroids
2. Mild trauma over age 50 years
3. Age greater than 70 years
4. History of Osteoporosis
5. Recent significant trauma at any age
  1. Ejection from motor vehicle
  2. Fall from substantial height
Red Flags: Abdominal Aortic Aneurysm red flags with Low Back Pain
1. Abdominal pulsating mass
2. Atherosclerotic vascular disease
3. Pain at rest or nocturnal pain
4. Age greater than 60 years
References

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.