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 (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:


  • 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


  • 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 He is a pharmacist and medical writer with more than 20 years of experience in medical education.

This article was updated on 15 Aug. 2000.6+