Low Back Pain Red Flags
1. Risk factors for cancer (If all three of these risk factors for cancer are absent, studies suggest that cancer can be ruled out with 100% sensitivity)
<-- Age 50 years old or older with a history of cancer
<-- Unexplained weight loss
<-- Failure to improve after four to six weeks of conservative low back pain therapy
2. Risk factors for possible spinal infection
<-- Intravenous drug use
<-- Immunosuppression
<-- Urinary infection
<-- Fever above 38°C (100.4°F) for greater than 48 hours
<-- History of tuberculosis or active tuberculosis
3. Signs or symptoms of Cauda Equina Syndrome
<-- New onset of urinary incontinence
<-- Urinary retention (if no urinary retention, the likelihood of Cauda Equina Syndrome is less than 1 in 10,000)
<-- Saddle anesthesia
<-- Unilateral or bilateral sciatica
<-- Sensory and motor deficits
<-- Abnormal straight leg raising
4. Increased risk factors for fragility fracture
<-- Osteoporosis
<-- History of steroid use
<-- Immunosuppression
<-- Serious accident or injury (fall from heights, blunt trauma, motor vehicle accident) – does not include twisting or lifting injury unless other risk factors are present (e.g., history of osteoporosis)
<-- Clinical suspicion of ankylosing spondylitis See Spondyloarthropathy Tool
<-- Drug or alcohol abuse (increased incidence of osteomyelitis, trauma, fracture)
5. Increased incidence of clinically significant pathology
<-- Unrelenting night pain or pain at rest
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