The following symptoms and complaints may indicate back pain or low back pain:
- Pain below the costal arch and above the gluteal folds, with or without radiation.
Accompanying other complaints may be present. If “ischialgia/lumboischialgia” is suspected, see under the topic of the same name. The Sk2 guideline “Specific low back pain” assumes that in the majority of cases a specific cause of low back pain can be found.
Warning signs (red flags)
The following are clues to the presence of specific causes:
- Anamnestic information:
- Age <20 years or >50 years:
- Children: progressive reluctance to walk and play.
- > 50 years with atypical lower back pain → think of: Prostate carcinoma/prostate cancer.
- Patients of advanced age → think of: Plasmocytoma (malignant neoplasm; non-Hodgkin’s lymphoma of B lymphocytes).
- Decrease in body size → think of: Osteoporosis (bone loss)
- Aortic aneurysm – wall bulge of the aorta.
- Inflammatory rheumatic disease (e.g., axial spondyloarthritis; typical symptoms: insidious onset of pain; morning stiffness (≥ 30 minutes); improvement of low back pain with exercise, not at rest; pain-related early morning/night awakenings; prolonged low back pain (> 12 weeks) and onset before age 45)
- Weight loss, unexplained
- Infections: HIV, tuberculosis
- Recent severe trauma* /contusion* (direct blunt force trauma).
- Minor trauma* (e.g., coughing, sneezing, or heavy lifting) in elderly or potential osteoporosis patients
- Nephrolithiasis (kidney stones).
- Osteoporosis (bone loss)
- Radiculopathies (chronic or acute irritation or damage to a nerve root)/neuropathies (collective term for many diseases of the peripheral nervous system).
- Tumor disease (the only confirmed warning sign of a malignant (malignant) event of the spine)/metastases (daughter tumors):
- Advanced age
- General symptoms: Weight loss, anorexia (loss of appetite), rapid fatigability.
- Pain that increases in the supine position
- Severe pain at night
- Drug history (intravenous drug use).
- Medication:
- Immunosuppression (measures to suppress defense responses).
- Long-term steroid therapy/therapeutic use of corticosteroids (> 6 months)* .
- Age <20 years or >50 years:
- Infection (fever > 38 °C; night sweats).
- Laboratory: CRP elevation, pathological (abnormal) urine findings.
- Urinary symptoms
- Localized pressure pain + elderly patient* → fresh osteoporotic fracture (fracture) possible.
- Morning stiffness > 1 h → suspected rheumatological disease (e.g. polymyalgia rheumatica, rheumatoid arthritis).
- Neurological symptoms
- Continence disorders (bladder and/or bowel dysfunction) [neurological emergency!]
- Breech anesthesia (loss of sensation of the genital and buttock region, as well as the inner thighs) + bladder emptying disorder (e.g., urinary retention, increased urination, incontinence) = Kauda syndrome).
- Paresis (paralysis)
- Meningismus (painful stiffness of the neck)
- Pain
- Acute pain after minor trauma
- Flank pain
- No decrease in pain at rest
- Night pain
- Back pain without limitation of mobility and without exacerbation during back movements → Suspicion of disease of other localization (e.g., kidney disease, pancreatic cancer (cancer of the pancreas), gastrointestinal disease/gastrointestinal disease, pelvic disease in women)
- Pain so severe that the affected person doubled over or writhing
- Chest pain
- Increasing pain
* Warning signs of fracture (broken bone)Bold: warning signs associated with an increased risk of a serious cause of the back pain.
