Signs indicating that you may have more than just back pain

Certain symptoms and conditions accompanying low back pain may indicate a patient is at risk of serious disease.
By John Russo Jr./Vicus.com

VICUS.COM (15 Aug. 2000) — Patients with low back pain who have these so-called “red flags” may be at risk of serious disease and require further medical evaluation and treatment.

Red flags that warn of a serious cause for back pain:

History

Change in bowel or bladder function
History of cancer
History of disorder with a predilection for infection (drug abuse) or hemorrhage (hemophilia)
History of metabolic bone disorder (increased incidence of fracture)
Intravenous drug use
Older patient who has new onset of back pain (especially if older than 50 years of age)
Pain is worse at night or not relieved by any body position
Pain onset not precipitated by significant trauma
Prolonged use of corticosteroids
Saddle anesthesia
Unintended weight loss
Urinary tract infection
Writhing pain

Physical Exam

	Bilateral radiculopathy
	Elevated sedimentation rate
	Fever
	Neurologic deficit not explained by monoradiculopathy
	Numbness or paresthesia in the perianal region
	Progressive neurologic deficit
	Pulsatile abdominal mass
	Unexplained significant lower limb weakness

Course

Lack of response to conservative measures within six weeks
Pattern of symptoms and physical findings not compatible with benign mechanical disease

But patients who do not have any of these symptoms during the history and physical examination may be treated conservatively.

John Russo, Jr. PharmD , is senior vice president of medical communications at Vicus.com. He is a pharmacist and medical writer with more than 20 years of experience in medical education.