Red Flag Signs in Back Pain

Neurological Emergencies (Cauda Equina Syndrome)

The most critical red flags involve the "Cauda Equina"—a bundle of nerve roots at the lower end of the spinal cord. Compression here is a surgical emergency.

• Saddle Anesthesia: Numbness or tingling in the "saddle area" (groin, buttocks, inner thighs, and genitals).

• Bladder or Bowel Dysfunction: Sudden inability to urinate (urinary retention), loss of control over urination (incontinence), or loss of bowel control.

• Progressive Leg Weakness: Sudden or worsening weakness in the legs that makes it difficult to stand or walk.

• Bilateral Sciatica: Pain, numbness, or tingling that radiates down both legs instead of just one.

Signs of Infection or Malignancy

Back pain can sometimes be a secondary symptom of a systemic issue like an infection (Osteomyelitis) or a spinal tumor.

• Unexplained Weight Loss: Losing weight without changes in diet or exercise.

• Night Pain: Intense pain that is worse when lying down or wakes you up from a deep sleep.

• Fever and Chills: Back pain accompanied by a fever, which may suggest a spinal abscess or infection.

• History of Cancer: If you have had cancer in the past (especially breast, lung, or prostate), new back pain should always be evaluated.

Trauma and Fracture Risks

Fractures can occur after an injury, but in individuals with weakened bones, they can happen with very little force.

• Significant Trauma: Pain following a car accident, a fall from a height, or a direct blow to the back.

• Osteoporosis: If you have known low bone density, even a minor event like a sneeze, a cough, or lifting a light object can cause a vertebral compression fracture.

• Steroid Use: Long-term use of corticosteroid medications (like prednisone) weakens bone structure and increases fracture risk.

Vascular Red Flags

In rare cases, what feels like back pain is actually a problem with the body's main artery.

• Pulsating Abdominal Mass: A "throbbing" sensation in the stomach area along with back pain can be a sign of an Abdominal Aortic Aneurysm (AAA).

• Tearing Sensation: Sudden, severe, "tearing" pain that radiates to the abdomen or chest.

Summary Checklist: See a Doctor

Urgent (ER)

Loss of bowel/bladder control, saddle numbness, sudden leg paralysis.

Priority (24-48h)

Fever with back pain, pain that prevents sleep, history of cancer.

Evaluation (Soon)

Pain lasting >6 weeks, pain following a fall, unexplained weight loss.