Lower back pain is a common symptom that links to a range of different conditions, and can be caused by a variety of factors, including musculoskeletal issues, nerve compression or other underlying medical conditions. Because lower back pain is connected to so many different health concerns, doctors may look for ‘red flags’ to help steer diagnosis.
So, what are the red flags for lower back pain? A red flag is a medical term for a clinical indicator of a possible serious underlying condition. It can be a sign or symptom, or a factor in a patient’s individual or family medical history.
If a doctor comes across a red flag in a patient, it may indicate the need for further investigation.
Red flags alone cannot be used to diagnose lower back pain, and just because a red flag is present does not mean that you have a serious condition. A doctor will consider other signs and symptoms, your age and lifestyle, any recent injuries or trauma, and medical history before proceeding with further investigations.
The Red Flags for Lower Back Pain
Private Rheumatologist Dr Naveen Bhadauria explains, “Most cases of lower back pain are caused by minor mechanical or soft tissue injuries, and patients will usually recover within four to six weeks. However, back pain can point to an underlying condition that requires specialist intervention. When consulting a patient, doctor and rheumatologists will look for red flags that may help indicate which investigations or referrals should follow.”
Red flags for lower back pain vary depending on the suspected condition. For example, the red flags for a congenital abnormality differ from those of an infection. Here are some red flags your doctor may be looking for:
Major trauma – a report of major trauma to the back, resulting in lower back pain, is a red flag for vertebral fractures, a fracture of one of the 33 bones in your back. Most patients will remember this trauma and be able to pinpoint when it happened. However, there are some instances, usually in those who are over the age of 55 and suffer from osteoporosis, where minor trauma causes the fracture due to the weakness of the bones.
Radiating pain – pain that radiates down the leg, especially if it follows a pattern such as the sciatic nerve distribution, may suggest nerve compression or irritation, such as in sciatica.
Numbness or weakness – a feeling of numbness, tingling or weakness in the lower extremities (hips, legs or feet) can indicate nerve involvement and may be associated with conditions such as spinal stenosis or herniated discs.
Pain or stiffness that does not improve with rest – if you have pain or stiffness in your back that may get better with exercise, but does not improve or even gets worse with rest, it may be a sign of ankylosing spondylitis. This is a long-term condition that causes inflammation of the spine and other areas of the body. Early intervention can help prevent or delay the process of fusing and stiffening of the spine with specialised immunomodulating medications.
Who to See for Lower Back Pain
If you are suffering from pain in your lower back, it is recommended that you see a rheumatologist. However, if certain red flags are uncovered, they may refer you to another specialist. These red flags include:
History of cancer – back pain with a history of cancer may suggest recurrence (where the cancer returns to the same area) or metastasis (where the cancer spreads to another part of the body).
Abnormal bleeding – abnormal vaginal or rectal bleeding combined with lower back pain may point to a gynaecological or rectal cancer.
Sudden weight loss – unintentional and sudden weight loss paired with back pain may indicate cancer, especially if the back pain worsens over time.
Red Flags For Lower Back Pain That May Indicate An Emergency
Sometimes, lower back pain, when presenting with certain other factors, may be a red flag for a condition that requires emergency care. These factors include:
Fever – there are a number of conditions that lead to fever with back pain, and most are linked to infection. These include kidney infection, osteomyelitis (bone infection), meningitis, and spinal abscess.
Anticoagulation use – anticoagulants are medicines that help prevent blood clots, but the use of these medicines is a red flag for spontaneous Spinal Epidural Hematoma (SSEH), a rare condition where blood accumulates in the epidural space (the space between the dura mater – the membrane surrounding the spinal cord – and the vertebrae). Treatment for this is usually a laminectomy (spinal decompression).
When to See a Rheumatologist About Lower Back Pain
Pain anywhere in the body, but especially the lower back, is not normal, so you should see a rheumatologist if you have any new pain that does not go away within a few days. Many causes of lower back pain can be relieved if addressed early, therefore it is important to avoid hesitation when booking your appointment.
Contact Dr Naveen Bhadauria on 0207 126 7264, or use our online booking form.
Article by Dr. Naveen Bhadauria
