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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)

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