Red and yellow flags for guiding imaging of lower back pain
Citation, DOI, disclosures and article data
At the time the article was created Craig Hacking had no recorded disclosures.View Craig Hacking's current disclosures
At the time the article was last revised Craig Hacking had the following disclosures:
- Philips Australia, Paid speaker at Philips Spectral CT events (ongoing)
These were assessed during peer review and were determined to not be relevant to the changes that were made.View Craig Hacking's current disclosures
Lower back pain (also known as lumbago) is very common and is often referred for imaging. However, the vast majority of cases are due to benign self-limiting causes which do not require imaging and resolve with conservative measures. Numerous authors have described various methods for supporting appropriate imaging for the investigation of lumbar back pain. One such system utilizes the idea of red flags and yellow flags.
Red flags are patient signs, symptoms or history that indicate possible serious pathology and hence support the decision to image the lower back. If no red flags are present, there is a negligible risk of serious pathology and the patient can be reassured that imaging is not indicated and treated with conservative measures.
Red flags include:
recent significant trauma
(prolonged or systemic) glucocorticoid use
age <20 or >55 years
radiculopathy (radiating pain with a dermatomal distribution pattern)
bladder or bowel dysfunction
severe or progressive sensory or motor disturbance
history of malignancy
pain worse at night or at rest
morning stiffness or improvement with movement
A useful mnemonic can be found here.
Yellow flags are psychosocial patient factors that although not associated with serious organic pathology nonetheless indicate an increased likelihood of chronic back pain and resultant long term disability and potential loss of work.
Yellow flags include:
a belief that pain and activity is harmful or severely disabling
the expectation that passive treatment rather than active participation will help
issues with the compensation system
poor job satisfaction
difficulty at work
lack of social support