Back pain red flags

Most people will suffer with temporary back pain at some point in their lives. However, the ability to spot the back pain ‘red flags’ – evidence of a potentially dangerous underlying condition – is a vital skill that clinicians should be competent in. 

History taking

A full physical examination and history taken should be carried out to determine if there’s any serious underlying cause of a patient’s back pain. If the pain is particularly severe, has lasted more than 6 weeks, the patient is very young or elderly or has a history of malignancy, or if the pain is accompanied by urinary and/or faecal incontinence or neurological signs, then these red flags must be treated as serious. 

The table below offers some indication:

Red flagsPossible causes
Duration > 6 weeksTumour, infection, rheumatologic disorder
Aged < 18 yearsCongenital defect, infection, tumour, spondylolysis, spondylolisthesis
Aged > 50 yearsTumour, intra-abdominal processes (such as abdominal aortic aneurysm), infection
Major trauma, or minor trauma in elderlyFracture
Fever, chills, night sweatsInfection, tumour
Weight lossInfection, tumour
Injection drug useInfection
Recent genitourinary or gastrointestinal procedureInfection
Night painInfection, tumour
Unremitting pain, even when supineInfection, tumour, abdominal aortic aneurysm, nephrolithiasis
Pain worsened by coughing, sitting or Valsalva manoeuvreHerniated disc
Pain radiating below kneeHerniated disc or nerve root compression below the L3 nerve root
IncontinenceCauda equina syndrome, spinal cord compression
Saddle anaethesiaCauda equina syndrome, spinal cord compression
Severe or rapidly progressive neurologic deficitCauda equina syndrome, spinal decompression longview tx

Can you confidently identify back pain red flags?

Spotting the red flags early can make all the difference to your patient’s treatment options and outcome. At PDUK we offer two particularly useful CPD courses covering this topic.

The first one is the Minor ailments essentials RCN Accredited course. Aimed specifically at nurses, non-medical prescribers, pharmacists, paramedics and other allied health professionals, the course was devised for those already confident in taking a history and physical examination but wanting to focus on the common and less common patient complaints seen in primary health care. Spread over 3 days, it’s worth a valuable 21 hours of CPD and is held entirely online.

Then there’s our Minor illness triage essentials course. Highly interactive, it focuses on essential observations, history taking and triaging patients effectively. It is specifically designed for healthcare professionals who regularly see patients with undifferentiated conditions, and all the major body systems are covered. Again, it’s held entirely online so perfect for remote learning, and is worth 7 hours of CPD over one day.

Both courses tend to book up quickly, so it’s well worth securing your place early.