lower back pain

Question 1

Red flags for acute back pain

Answer 1

1. Cancer - history of metastatic cancer to bone, weight loss unexplained, vertebral tenderness, limited ROM
2. Cauda equina - bladder or bowel incontinence, urinary retention, progressive motor or sensory loss, loss of anal sphincter tone, saddle anesthesia
3. fracture; significant trauma related to age, vertebral tenderness, limited ROM, history of steroid use
4. Infection: fever, wound in spine, severe pain, lumbar spine surgery in the past year, IVDU,

Question 2

What is the approach to investigation for acute back pain?

Answer 2

imaging in not warranted for most people.
Consider imaging if highly suspicious of red flag conditions.

Lab tests may be beneficial if infection or bone marrow neoplasm is suspected.