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Red and Yellow Flags For Pain
Red and Yellow Flags For Pain
Red Flags
Possible fracture
From history
Major trauma
Minor trauma in
elderly or
osteoporotic
Possible tumour or
infection
Possible significant
neurological deficit
Severe or progressive
sensory alteration or
weakness
Bladder or bowel
dysfunction
Evidence of
neurological deficit (in
legs or perineum in the
case of low back pain)
The presence of red flags in acute low back pain suggests the need for further investigation and
possible specialist referral as part of the overall strategy. If there are no red flags present in this
situation it is safe to reassure the patient and move ahead with a multimodal management
approach.
Yellow Flags
1. Yellow flags can relate to the patients attitudes and beliefs, emotions, behaviours,
family, and workplace. The behaviour of health professionals can also have a major
influence.
2. Key factors in low back pain are:
The belief that pain is harmful or severely disabling
Fear-avoidance behaviour (avoiding activity because of fear of pain)
Low mood and social withdrawal
Expectation that passive treatment rather than active participation will help.
The presence of yellow flags may highlight the need to address specific psychosocial factors as
part of a multimodal management approach.
References
1. New Zealand Low back Pain Guide. Accident Rehabilitation and Compensation Insurance
Corporation of New Zealand and the National Health Committee. Wellington 1997.
2. Low Back Pain: Rational use of opioids in chronic or recurrent non-malignant pain. NSW
Therapeutic Assessment Group: Prescribing guidelines for primary care clinicians. Published
1998. Revised 2002.