Back pain with or without leg pain - under 6 weeks which is not caused by malignancy, infection, fracture and inflammatory disorders e.g. Ankylosing Spondylitis. But may include flare-up of persistent non-specific pain.
Serious pathology in the absence of an obvious cause (eg trauma) is very rare, but be aware of signs suggestive of more serious pathology.
Symptoms suggestive of cauda equina syndrome (compression of the cauda equina):
Significant symptoms that may suggest cancer:
Other symptoms that may suggest cancer include:
Symptoms that may suggest infection:
Symptoms that suggest fracture:
Red flags may also be indicated by:
NB: Be aware that some red flags have very high false-positive rates and as such have little diagnostic value in primary caresettings. Careful clinical judgment to decide whether to investigate further or refer is needed.
Patients with any of the following suspected should be sent to A&E:
Consider urgent referral to Consultant Spinal Surgeon Clinic (where certain of malignancy contact Oncology):
Urgent referral to Rheumatology Clinics for suspected spondyloarthropathy:
Consider diagnosis (discuss within peer review)
Risk Factors for back pain:
Consider using risk stratification tool - http://www.keele.ac.uk/sbst/startbacktool/
If not improved at 2-6 weeks:
If not responding consider onward referral to Interface Team.
If not responding consider:
If not responding after comprehensive conservative treatments and fits criteria consider referral to surgeon or pain medicine.
Only consider MRI when a diagnosis of spinal malignancy, infection, fracture, cauda equina syndrome or ankylosing spondylitis or another inflammatory disorder is suspected.