Knowing about some of the red flag signs may be of help to the patients in deciding if they need to get an early medical attention for their spinal pain. So, these are some of the red flags that a common person can identify:

1. Pain at rest or night pain/sleep disturbance due to pain: The usual mechanical back pain gets better with some rest and is unlikely to disturb sleep. Any back or neck pain that is not relieved by rest or wakes you up from sleep in the night should be considered as serious and needs relevant imaging of the spine.
2. Duration of pain: Any pain that persists for more than 4 weeks despite usual measures like rest, physiotherapy and medication needs further evaluation and one must see a spine specialist in such a situation.
3. Age: As one ages, the risk of tumours in various organs of the body increases. Some of the tumours are aggressive and can spread through the blood stream (metastasis) to the bones as well as other organs. Spine is the most common location of such spread. Any person over the age of 50 years with persistent back or neck pain should undergo a clinical evaluation and imaging if required based on the examination. Any one with a prior history of cancer developing a back pain should be evaluated immediately to rule-out a spinal metastasis.
4. Unexplained weight loss: Any weight loss of more than ten percent of body weight in less than six months of time is considered as significant. An unexplained weight loss could be due to a cancer or infection and needs a thorough evaluation.
5. Compromised immunity: Conditions that impair the immunity like diabetes, prolonged steroid intake etc could lead to infection in the spine that could be the cause of back pain. So back pain in immunocompromised patients, especially if associated with fever or weight loss or loss of appetite are considered as red flags and needs immediate further evaluation.
6. Inability to walk due to weakness in major muscles of lower limbs, numbness (loss of sensation) or paraesthesias ( tingling or pins & needles sensation) in the limbs or in the perianal region, loss of bladder or bowel control – all indicate a possible spinal cord or nerve root compression in the spine. The cause for such neurological deficit needs to be immediately identified and treated accordingly.
7. Smoking: Current or past smokers are at a high risk of developing cancer. They are also at risk of osteoporosis and thereby osteoporotic vertebral fractures.
8. Trauma: Significant trauma in young individuals can cause a fracture in the spine. In the elderly, the bones are weak and can easily fracture. Even a trivial fall can cause a fracture in the elderly, especially ladies. Any past history of osteoporotic fracture in the past is also significant in this scenario.

So, if you or someone close to you are experiencing persistent back or neck pain and have one or more of the above mentioned red flag signs, it clearly warrants a visit to your doctor as soon as possible, as it could be something more serious than a usual strain related back pain.

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