What are the red flags when it comes to back pain?

The fact is that many conditions share similar symptoms, and it’s not always easy to know when pain is the result of something benign or more serious. This is why it’s crucial to carry out a thorough patient examination and history taking, whilst looking out for any red flags – especially with back pain.

Of course, back pain in people of all ages is incredibly common. It’s usually temporary and doesn’t require any specific treatment. However, sometimes back pain can point to a more serious or chronic condition, such as neurological problems or certain cancers.

It is essential that primary care practitioners minimise the risk of missing a serious illness. A key part of this is in recognising the “red flags”.


What are red flags?

Red flags are indicators of an underlying condition that is more serious than it may first appear. Possessing the skills to recognise back pain red flags is vital, because the earlier a condition is diagnosed the quicker and potentially more effective the treatment plan. 

Remember that some red flags are more immediately obvious than others.


When a patient presents with back pain, what are the most concerning red flags to look out for?

In the UK, back pain is one of the most common ailments healthcare professionals are presented with. Sometimes it’s the first time a patient has experienced the pain, but often it’s the result of a chronic problem. However, if back pain is accompanied by any of the below alarm symptoms there may be a serious underlying cause and must be investigated further. This is particularly the case if the patient is:

  • Also experiencing thoracic pain
  • In extremely severe or debilitating pain
  • Suffering a weakness or numbness in their arm(s) or leg(s)
  • Experiencing incontinence, either bladder or bowel
  • Showing signs of a fever
  • Displaying an unusual gait, or foot drop
  • At risk of cancer or has had cancer before
  • Experiencing saddle anaesthesia (numbness of the anus, perineum or genitals)
  • Aged under 20 years or is older than 55

These symptoms could be due to an infection, spinal cord compression, potential cauda equina syndrome or a tumour. Establishing the exact location and type of pain is essential.


Other factors to consider

In addition to the symptoms mentioned above, healthcare professionals should also be aware of: 

  • Trauma (for example of the patient has been in a recent road traffic accident or has had a fall from height)
  • Any other recent injuries or illnesses
  • Whether the patient has experienced any unexplained weight loss
  • Any steroid use
  • Any pre-existing medical conditions
  • Any problems passing urine or stool

Gradual onset of back pain in patients under 40 could indicate an inflammatory condition. It’s extremely important to ascertain the patient’s history of cancer because the primary site or any metastases could be causing the back pain.


What may have caused these red flags to have occurred?

As well as infections, fractures or cancer, other possible causes include:

  • Peripheral neuropathies
  • Lumbar disc herniation
  • Cauda equina syndrome
  • Disease of vascular, rheumatoid or visceral origin.


Can you confidently determine the red flag signs concerning back pain?

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. 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. Spaces soon fill up so it’s worth booking up early.

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 of the major body systems are covered. Again it’s held entirely online so perfect for remote learning.

This course is worth 7 hours of CPD over 1 day. Again, secure your place early!

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