Red flags are signs & symptoms that might indicate serious pathology. In the lumbar spine, the following specific red flags will have to be excluded before you can continue with your patient history-taking:
| Red Flag | Signs & Symptoms |
| Malignity | >50y of age, movement-independent pain, nocturnal pain, general malaise, cancer in history, unexplained weight loss, elevated erythrocyte sedimentation rate (ESR) |
| Osteoporotic vertebral fracture | Recent fractures (<2 years), previous vertebral fractures, age>60y, <60kg body weight or BMI<20, older person with hip fracture, prolonged use of corticosteroids, local percussion pain, tenderness over the spine, reduced height or increase in thoracic kyphosis |
| Ankylosing Spondylitis (Bechterew’s Disease) | Age < 20y, male gender, iridocyclitis, peripheral arthritis, inflammatory bowel disease, nocturnal pain, morning stiffness >1h, pain reduction when lying down or exercising, good response to NSAIDs, elevated erythrocyte sedimentation rate (ESR) |
| Vertebral fracture | Severe pain after trauma |
| Severe spondylolisthesis | Age <20y, palpable misalignment of vertebral body L4 and L5 |
If you recognize a pattern or if you have a feeling of uncertainty, you should always refer the patient back to the general practitioner.
The guideline recommends to use the NPRS or VAS scale to assess pain. For limitations in activity and participation, the PSC scale is recommended to assess the patient-specific complaints.
In order to evaluate function, the guideline recommends the Quebec Back Pain Disability Scale (QBPDS)
In case of recurring low back pain extra attention should be given to the following possible underlying causes of recurrence:
- Are there any changes in workload?
- Pressure of work?
- Activities involving body movements?
- Duration: Episodes of pain vs. pain-free episodes in-between
- Implementation of ergonomic recommendations?
- How is the patient’s compliance with earlier therapy?
| Study | |||||
| KNGF (2013) |
