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Red Flags in Back Pain

When assessing patients with back pain we talk about Red Flags, which are symptoms and signs raising suspicions of something going on which may be more serious, such as infection, tumour or other causes.


Doctors look for certain factors called Red Flags that could indicate that somethng is going on in the back that could cause concern.  In addition, other factors called Yellow Flags can be indicators of increased risk of back pain becoming chronic.

Anyone with these symptoms with back pain should seek immediate medical care - they could indicate the development of a condition called cauda equina syndrome:

  • Difficulty passing urine or having a bowel movement, or numbness in the "saddle area"
  • Progressive weakness in the legs
  • Severe, continuous abdominal and low back pain.

People should also seek prompt medical attention if other unexplained symptoms accompany their back pain, such as fever, history of cancer, recent unexplained weight loss, pain that is so bad it awakens them from sleep, or pain after a trauma.  There are several warning signs, known as red flag signs, that may indicate that your back pain is caused by a more serious condition that requires immediate medical help. These include:

  • a fever of 38ºC (100.4ºF) or above
  • unexplained weight loss
  • swelling of the back
  • constant back pain that does not ease after lying down
  • pain in your chest or high up in your back
  • pain down your legs and below the knees
  • pain caused by a recent trauma or injury to your back
  • loss of bladder control
  • inability to pass urine
  • loss of bowel control
  • numbness around your genitals, buttocks or back passage
  • pain that is worse at night


Red Flags

  • Age of onset less than 20 yrs or more than 55yrs
  • Recent history of violent trauma
  • Constant progressive, non mechanical pain (no relief with bed rest)
  • Thoracic pain
  • Past medical history of malignant tumour
  • Prolonged use of corticosteroids
  • Drug abuse, immunosuppression, HIV
  • Systematically unwell
  • Unexplained weight loss
  • Widespread neurological symptoms (including cauda equine syndrome)
  • Structural deformity
  • Fever








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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
email: pain.webmaster[at]

Page updated 15/02/2016