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Medical Author:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Medical Editor:

Jerry R. Balentine, DO, FACEP

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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When to Seek Medical Care

The Agency for Healthcare Research and Quality has identified 11 red flags that doctors look for when evaluating a person with back pain. The focus of these red flags is to detect fractures (broken bones), infections, or tumors of the spine. Presence of any of the following red flags associated with low back pain should prompt a visit to your doctor as soon as possible for complete evaluation.

• Recent significant trauma such as a fall from a height, motor vehicle accident, or similar incident



• Recent mild trauma in those older than 50 years of age: A fall down a few steps or slipping and landing on the buttocks may be considered mild trauma.



• History of prolonged steroid use: People with asthma, COPD, and rheumatic disorders, for example, may be given this type of medication.



• Anyone with a history of osteoporosis: An elderly woman with a history of a hip fracture, for example, would be considered high risk.



• Any person older than 70 years of age: There is an increased incidence of cancer, infections, and abdominal causes of the pain.



• Prior history of cancer



• History of a recent infection



• Temperature over 100 F



• IV drug use: Such behavior markedly increases risk of an infectious cause.



• Low back pain worse at rest: This is thought to be associated with an infectious or malignant cause of pain but can also occur with ankylosing spondylitis.



• Unexplained weight loss

The presence of any of the above would justify a visit to a hospital's emergency department, particularly if your family doctor is unable to evaluate you within the next 24 hours.

• The presence of any acute nerve dysfunction should also prompt an immediate visit. These would include the inability to walk or inability to raise or lower your foot at the ankle. Also included would be the inability to raise the big toe upward or walk on your heels or stand on your toes. These might indicate an acute nerve injury or compression. Under certain circumstances, this may be an acute neurosurgical emergency.



• Loss of bowel or bladder control, including difficulty starting or stopping a stream of urine or incontinence, can be a sign of an acute emergency and requires urgent evaluation in an emergency department.



• If you cannot manage the pain using the medicine you are currently prescribed, this may be an indication for a reevaluation or to go to an emergency department if your doctor is not available. Generally, this problem is best addressed with the doctor writing the prescription who is overseeing your care.