How many of us get on google to self-diagnose ourselves, only to come away convinced that we either have cancer or a tumor? Now, I do not want to make light of any of those conditions, sadly I have had experiences with patients coming in for what initially seemed like a routine musculoskeletal condition end up having a much or serious diagnosis.
What I would like to go through today is a list of common signs of something that might be more serious than just routine back pain. I think that having the knowledge of what the more serious conditions look like can decrease the stress and anxiety that goes along with normal acute or chronic back pain. We term these “red flags” to use as a warning sign that indicate that the back pain we are dealing with is not just common low back pain. There was a study that looked at a large group of patients with low back pain and nearly all had at least one flag, but less than 1% actually had some serious pathology. So, just one flag in isolation does not automatically mean that something is serious. So seriously, that being said, here are 5 serious pathologies to seriously be aware of when it comes to serious back pain (have I used the word serious enough?).
- Cancer
- a. Previous history of cancer (most important predictor)
- Night pain or pain at rest
- Unexplained weight lost
- Age > 50 years or < 17 years old
- Failure to improve over the predicted time interval following treatment
- Infection within the disk or vertebrae
- The patient is immunosuppressed
- A prolonged fever with a temperature over 100.4F
- History of intravenous drug abuse
- History of recent urinary tract infection, cellulitis, or pneumonia
- Vertebral fracture
- Prolonged use of corticosteroids
- Mild trauma age > 50 years
- Age > 70 years
- A know history of osteoporosis
- Recent major trauma at any age (car accident or fall greater than 5 feet)
- Bruising over the spine following trauma
- Aortic aneurysm
- A pulsating mass in the abdomen
- A history of atherosclerotic vascular disease
- A throbbing, pulsing back pain at rest or with lying down
- Age > 60 years
- Cauda Equina Syndrome
- Urine retention
- Fecal incontinence
- Saddle anesthesia (numbness around the groin area)
- Sensory or Muscle Strength deficits in the feet
Now if after reading this list you think, “well I have back pain at night!” or “I’m over 70 years old!” remember that one thing in isolation is not a significant sign. There needs to be at least 2 or more. And remember that 99% of the time it is not any of these things. Hope that helps relieve some of the stress!