Lower back pain is a complaint that is seen very often in a medical appointment. Most of these pains are unimportant and will heal with the passage of weeks. Doctors are concerned about detecting cases that are not simply mechanical back pain. We know that from time to time a patient who has something serious comes and goes with complaints similar to those of everyone else. In order to help the doctor detect these cases the red flags were devised.
The red flags are a list of symptoms that would indicate a greater risk of having a serious problem in the back. These symptoms are included in many medical guides. The idea is to do a test of image immediately before a symptom of this list that is present in a patient with acute low back pain. Depending on the suspicion, this test may be an X-ray, a CAT scan or an MRI.
All that we are talking about refers to consultations for low back pain without including injuries such as a fall or a motorcycle accident, for example. These would enter into other considerations. Of the people who go to the clinic to assess low back pain, fortunately less than 1% will have this risk of seriousness that we are talking about.
All this also has the reverse reading that most pains do not require a picture test in the first 4 to 6 weeks. This is because most will be non-specific pains that will heal on their own.
The red flags today are highly questioned. On the one hand they represent a long list of symptoms that are different depending on the guide you choose. On the other hand, many of the symptoms contained in these lists are not shown to have the meaning given to them. The lack of consensus has relegated them today. What is clear is that the doctor has in mind the serious problems that he does not want to be missed when a patient with low back pain appears in the consultation. I am going to tell you the main suspicions that doctors are looking for and some of the most recognized symptoms that put us on the alert:
– Symptoms suggesting a ponytail syndrome: Retention of urine (that we are not able to urinate despite being full of bladder), urinary incontinence or feces (that we make our needs involuntarily) or that we have Anesthetized the area surrounding the anus and between the anus and the genitals. These symptoms suggest a lesion of the sacral roots, which in itself is a serious consequence regardless of the cause. The cause can be a huge herniated disc (most common), a tumor, a bleeding or others.
– The appearance of weakness in different muscle groups of the lower limbs are a sign of alarm that indicates the possible injury to the lumbar nerve roots.
– If we have had a cancer recently or are going through one at the time of the consultation. Here you can also include people at risk of suffering from a cancer because of their personal history or who are suspected of symptoms or risk factors that the patient has.
– Infections are another cause that worries doctors. There are factors that suggest a high risk of infection in the spine, either by presenting symptoms or by your personal and medical history. For example, an immunosuppressed person (whether due to illness or medication) or someone who has been a long time with a fever or who has an infection that may have spread. Other factors, such as a patient on hemodialysis or an injected drug addiction, can put us on the alert for a possible infection.
– The possibility of having a fracture without significant trauma is a reality in some patients. A person who has taken corticosteroids for a long time or who is a long time with osteoporosis, for example, warns us that the pain may be due to a fracture.
– Sometimes the problem is not in the back and can produce a situation of vital risk as is the abdominal aortic aneurysm. This is suspected in an elderly patient with pain that is not removed by rest, in which there is no position without pain and in which we discover a pulsatile mass in the abdomen.