Red flags presented in current low back pain guidelines: a review

Verhagen, Arianne P.; Downie, Aron; Popal, Nahid; Maher, Chris; Koes, Bart W.

doi:10.1007/s00586-016-4684-0

Table 3 Red flags endorsed unrelated to specific disease

From: Red flags presented in current low back pain guidelines: a review

Red flag	Endorsed by guideline
Pain
Onset of pain <20 or >50 years old	Austria, Europe, Malaysia, Norway, Philippine, Spain
Constant, progressive, nonmechanical pain	Canada, Europe, Philippine
No pain relief with bed rest	Europe
Thoracic (or abdominal) pain	Austria, Europe, Malaysia, Philippine, Spain
(Continuous) Pain at rest^a	Austria, Canada, Malaysia, New Zealand, Norway
(Increasing) Pain at night^a,c	Canada, Malaysia, New Zealand
Pain increase in flexion	Austria
Increasing pain despite treatment	Austria
Pain at night that is not eased by a prone position (or increasing in supine position)^a	Philippine
History of malignancies/cancer^a	Austria, Canada, Europe, Malaysia, New Zealand, Norway, Philippine, Spain
(Unexplained/unintentional) Weight loss^a	Austria, Canada, Europe, Malaysia, New Zealand, Norway, Philippine
Fever ≥38 °C^a,c	Austria, Canada, Europe, Malaysia, New Zealand, Philippine, Spain
General malaise^a	Austria, Norway, Spain
Elevated erythrocyte sedimentation (ESR)^a	Norway
Age over 50 years^a	New Zealand
(History of) Major/significant trauma^b	Austria, Europe, Malaysia, New Zealand, Norway, Philippine, Spain
(Structural spinal) deformity^b	Austria, Europe, Malaysia, Norway, Spain
(Systemic) Use of steroids^b	Malaysia, New Zealand,
Osteoporosis^b	Austria, Malaysia
Intravenous drug abuse/drug addiction^c	Austria, Europe, Malaysia, New Zealand, Norway, Spain
Use of corticosteroids or immunosuppressant therapy^c	Austria, Europe, Norway, Philippine, Spain
Immunodeficiency/HIV/AIDS^c	Austria, Europe, Malaysia, Philippine, Spain
Saddle anesthesia/perineal numbness^d	Malaysia, Philippine
(Sudden onset) Bladder dysfunction (e.g. urinary retention, overflow incontinence)^d	Malaysia, Philippine
(Wide) Spread sensory deficit (in lower limbs)^d	Austria, Canada, Europe, Norway, Spain
Progressive weakness in lower limbs/lower motor neuron weakness^d	Malaysia
Gait disturbance/abnormality^d	Malaysia
Progressive weakness in lower limbs/lower motor neuron weakness^d	Malaysia
Significant limitation of lumbar flexion	Malaysia, Philippine
Not flexion of 5th lumbar spine	Spain
Morning stiffness	Norway

^aEndorsed elsewhere for malignancy, ^bendorsed elsewhere for fracture, ^c endorsed elsewhere for infection, ^dendorsed elsewhere for CES

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