Let’s face it – low back pain hurts.  And when it really hurts to the point where we can’t move without wincing or crying it can become scary.  It doesn’t take long for a bout of low back pain to go on before we start to worry if it will affect our personal and professional lives.

The good news is that most low back pain is not serious and most bouts of low back pain (80% of all cases) resolve themselves in 6 to 8 weeks.  For the people who end up missing work because of low back pain, 50% will return within 2 weeks while 83% will return within 3 months.

What a relief, right?  Chances are you are part of the majority of people who will get better in one and a half to two months.  But even with these odds, when I tell people this I am always met with skepticism.  It is for that reason that I want to talk about red flags related to low back pain.

“Red flags” is a term used in the medical community for signs or symptoms that may indicate that something more serious like cancer or infection may be present.  These are the types of illnesses that should be taken seriously and brought to the attention of your primary care physician immediately.  In the absence of a cluster of red flags, chances are you don’t have something seriously wrong with your back.  However, if you have read this far, I’m guessing you want to know A) What qualifies as a “red flag?” and B) What are the signs and symptoms?

Number one on the list of red flags is cancer.  The following items below may increase the likelihood of having metastatic cancer.

  • History of cancer
  • Night pain or pain at rest
  • Unexplained weight loss
  • Age > 50 years or < 17 years old
  • Failure to improve over the predicted time interval following treatment

Number two on the list of red flags is an infection within the disk (diskitis) or vertebrae (osteomyelitis).

  • The patient is immunosuppressed
  • A prolonged fever with a temperature over 100.4 degrees F
  • History of intravenous drug abuse
  • History of a recent urinary tract infection, cellulitis or pneumonia

Number three on the list of red flags is an undiagnosed vertebral fracture.

  • Prolonged use of corticosteroids
  • Mild trauma age > 50 years
  • Age > 70 years
  • A known history of osteoporosis
  • Recent major trauma at any age (motor vehicle accident or fall form greater than 5 ft)

Number four on the list of red flags is a dangerous abdominal aortic aneurysm.

  • A pulsating mass in the abdomen
  • A history of atherosclerotic vascular disease
  • A throbbing, pulsing back pain at rest or with recumbency
  • Age > 60 years

Number five on the list of red flags is Cauda equine syndrome

  • Urine retention or incontinence
  • Fecal incontinence
  • Saddle anesthesia
  • Global or progressive weakness in lower extremities
  • Sensory deficits in the feet
  • Ankle dorsiflexion, toe extension and ankle plantarflexion weakness

The take home message is this – serious diseases presenting as low back pain are rare and traditional red flags like the ones mentioned above are often present in people who do not have serious disease.  It is also important to remember that having one red flag present with your presentation of low back pain does not significantly increase your likelihood of serious disease.  However, your probability does go up with an increased number of positive red flags in any given group.

It should be noted that none of this information should be considered diagnostic, but rather informational to help you make better decisions about your heath.  Only a medical professional can properly diagnose your condition.  If you are still concerned that your low back pain may be something serious please do not hesitate to contact us with your questions at 479-402-9400 or reach out to your primary care physician.

Dr. Christian Robertozzi

Author Dr. Christian Robertozzi

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