Chronic Pain Red Flags
The presence of ‘Red Flags’ indicate:
- possible serious underlying pathology
- the need for further investigation
Consider a history of cancer as a red flag, especially in back pain. Unstable vital signs or fever require exclusion of acute pathology.
Red Flags1 |
Spinal fracture | Spinal tumour or infection | Cauda equina syndrome | Headache | Abdominal pain |
Major trauma with tenderness | Age < 16 or > 50 | Bladder and bowel dysfunction | Head trauma | Age < 16 or > 50 | |
Minor trauma in the elderly or osteoporotic | Fever, chills or weight loss | Progressive weakness or sensory loss | Persistent vomiting | Persistent vomiting | |
Pain worsening at night or when supine | Evidence of neurological deficit (legs or perineum) | Thunderclap or worst ever headache | Female of child bearing age | ||
IV drug use | New neck pain | Recent ED presentation | |||
Immunosuppression | Immunosuppression | ||||
Recent bacterial infection | Altered mental state | ||||
Visual loss | |||||
Seizure | |||||
Investigations | CT | Inflammatory markers MRI | MRI | CT/MRI | bHCG US scan /CT |
Referral to | Neurosurgery / Orthopaedics | Neurosurgery / Orthopaedics | Neurosurgery / Orthopaedics | Neurology / Neurosurgery | General surgery / O &G / Gastroenterology |
Further References and Resources
1) Low Back Pain: Rational Use of opioids in chronic or recurrent non malignant pain. NSW Therapeutic Assessment Group: Prescribing Guidelines for Primary Care Clinicians. Published 1998. Revised 2002 (Sourced 24/2/14)