Back pain (red flags)

Traditional Red Flags

History

1. Pain >6wks
2. Age >50<18
3. Hx of trauma
4. Sciatica
5. Neurological complaints (paresthesias, anesthesia, weakness)
6. Incontinence of bowel or bladder
7. Night pain
8. Unrelenting pain despite analgesics
9. Fever, chills, night sweats
10. Hx of IVDU
11. Hx of CA

Physical Exam

1. Fever
2. Pt writhing in pain
3. Point vertebral tenderness
4. Neurological deficits
5. Positive SLR

Specific Condition Red Flags

Cancer Related

1. Hx of back pain
2. Weight loss>10kg in 6 months
3. Age>50 <18
4. No improvement despite therapy
5. Pain for 4-6 weeks
6. Night pain
7. Pain worse at rest
8. Vertebral tenderness

Infection Related

1. Persistent fever
2. History of IVDA
3. Recent infection
4. Immunocompromised state
   1. Systemic Corticosteroids
   2. Transplant
   3. Diabetes
5. HIV

Cauda Equina

1. Incontinence or retention
2. Saddle anesthesia
3. Decreased anal sphincter tone
4. Bilateral lower extremity weakness or numbness
5. Neurologic deficit

Herniated Disc

1. Muscle Weakness
2. Radiation of pain
3. Footdrop

Vertebral Fracture

1. Prolonged use of corticosteroids
2. History of osteoporosis
3. Age>70
4. Mild trauma in age > 50
5. Significant trauma in any age
6. Bony tenderness

AAA

1. Risk factors for PVD
2. Pulsating mass
3. Pain at rest or at night
4. Age > 60 years

See Also

Ortho: Lower Back Pain