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Chronic Pain Yellow Flags

The presence of ‘Yellow Flags’ indicate greater risk of progression to psychological distress and disability relating to pain and its management. They include beliefs, emotions, behaviours and supports1. They indicate the need for GP involvement, consideration of a Mental Health plan and psychological therapies.

The OMSPQ-10 questionnaire identifies some of these belief patterns and a score of >50/100 predicts an increased risk of disability at one year2 or a heightened level of distress at the time of presentation.


Depression / anxiety


Belief that pain is a sign of damage

Expectation of curative passive treatments


Avoidance of activity and social interaction due to fear of pain

Use of extended rest

Increased use of alcohol and other drugs

Social Support

Unsupportive or overprotective partner / family


Unsupportive work environment

Prolonged time off work

Note: Urgent Mental Health Review is indicated for suicidal ideation.

Further References and Resources

1) New Zealand acute low back pain guide: Incorporating the guide to assessing psychological yellow flags in acute low back pain. Accident Compensation Coorporation Wellington, 2004. (Sourced 24/2/14)

2) Development of a short form of the Örebro Musculoskeletal Pain Screening Questionnaire. Linton SJ, Nicholas M, MacDonald S. Spine (Phila Pa 1976). 2011 Oct 15;36(22):1891-5

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