Recognising back pain red flags: When to seek immediate medical attention

Back pain is a common complaint that can vary from minor discomfort to severe, debilitating pain. While most cases resolve with simple treatment, certain signs - often referred to as "red flags" - indicate the possibility of a serious underlying condition.

This article provides a comprehensive guide to help you recognise back pain red flags, know when to act, and understand how back pain is treated.

What are red flags in back pain?

In the context of back pain, “red flags” refer to specific symptoms or signs that suggest a serious underlying condition, such as fractures, spinal infections (discitis or spinal abscesses), autoimmune conditions, nerve compression, or even cancer.

Common red flags in back pain include:

• persistent pain that doesn’t improve with rest or over-the-counter medication
• radiating pain down one or both legs, often accompanied by numbness or tingling
• sudden weakness in the legs, making walking or movement difficult
• loss of bladder or bowel control
• fever, chills, or night sweats
• unexplained weight loss
• pain after recent trauma, such as a fall or car accident
• pain in people with a history of cancer, osteoporosis, or immune system compromise

Unlike general back pain, red flag warning signs require urgent medical evaluation to prevent complications and long-term harm.

When should I seek immediate medical attention for back pain?

You should seek immediate medical attention if you experience any of the red flags mentioned earlier, particularly if symptoms worsen rapidly or are accompanied by other concerning symptoms. For instance, if you lose sensation in the groin area, it could indicate cauda equina syndrome, a rare but serious condition that requires emergency surgery.

While back pain is rarely life-threatening, conditions like spinal cord compression, cauda equina syndrome, and severe infections require emergency intervention. In some cases, delays in treatment can lead to permanent damage, including paralysis or nerve damage.

How is back pain assessed and treated?

When you present with back, especially with red flag symptoms, a specialist (such as a consultant rheumatologist) will take a thorough approach to assess and evaluate your condition. This will typically begin with a detailed medical history review, in which your rheumatologist will ask questions about the onset, location, and severity of your pain, as well as any accompanying symptoms like numbness, weakness, or fever.

Your rheumatologist will then perform a physical examination to assess your posture, range of motion, and reflexes. In some cases, neurological tests may also be performed to evaluate sensation, muscle strength, and coordination.

To determine the underlying cause of your back pain, your rheumatologist will order several diagnostic tests, including:

• Imaging tests: X-rays, MRIs, or CT scans are performed to identify structural issues like fractures, disc herniations, or tumours. MRI scans are particularly useful for detecting soft tissue problems and nerve compression.
• Laboratory tests: Blood tests may be ordered to identify signs of infection (elevated white blood cell count) or inflammation (elevated CRP or ESR levels). If cancer is suspected, specific tumour markers may be tested.
• Bone density scans: In cases of suspected osteoporosis, a bone density test may be performed to evaluate the risk of fractures.

Treating serious back pain depends on the underlying cause. Infections require antibiotics, fractures may need surgical repair, and autoimmune conditions often respond to disease-modifying therapies. The key is early intervention to address the underlying issue of back pain, thereby preventing complications and improving outcomes.