This website uses cookies to give you the best experience. By continuing to use this website you are consenting to cookies being used. You can delete and block cookies from within your browsers settings. For more information please refer to our privacy and cookie policy page.


Red Flags - Back Pain

Indications for urgent referral include:

  • painful scoliosis.
  • night waking.
  • neurological symptoms suggestive of nerve root entrapment or cord compression e.g., cough impulse, pins and needles, nerve root pain or sphincter disturbance (bladder / bowel).
  • systemic findings to suggest malignancy or sepsis.
  • very young children (<5 years) (although the most likely cause is still mechanical).
  • suggestion of inflammatory back pain (morning stiffness / pain).

The differential must include infection (abscess, osteomyelitis), malignancy or an orthopaedic emergency (such as prolapsed disc or spondylolisthesis). These may be suggested by red flags in the clinical assessment. Clinical concern warrants urgent referral and do not wait for investigations. Refer to orthopaedics or paediatric rheumatology depending on the clinical presentation.

The MRI below shows a spinal cord tumour presenting with back pain, night waking and nerve root symptoms

Site Statistics

To date (end of August 2021) PMM has >910,640 hits and >376,455 users from 221 countries!

Why register?

Some parts of PMM which involve pictures or videos of children, can only be viewed by registered users. Registering also allows you to bookmark favourite pages and track your viewing.

find out more

Short online courses

from Newcastle University, UK

e-resources from PMM

pmm for you

Please help us ensure pmm is as useful to you as possible by completing this short survey

complete survey