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Parcours de soins pour les lombalgies

Date de la dernière mise à jour : février 2024

Signs or Symptoms of Pathology (Red Flags)

 

Clinical Cornerstone: Consider asking additional questions that help evaluate for the presence of red flags in low back pain. Red flags are symptoms or signs that may indicate a serious pathology and should be deliberated in the clinician’s differential diagnosis.

  • Spinal fracture

    • Red flags: history of osteoporosis, corticosteroid use, severe trauma, female sex, older age, history of spinal fracture, history of cancer, history of falls.

    • Action: Refer to appropriate provider for imaging especially if pain is sudden in onset and pain is severe.

 

  • Spinal malignancy

    • Red flags: history of cancer, unexplained weight loss, unexplained significant night sweats, pain worse at night.

    • Action: Refer to an appropriate provider.

  • Spinal infection

    • Red flags: intravenous drug use, poor living conditions, immunosuppression, recent surgery/invasive interventions, history of TB (tuberculosis)/born in TB-endemic country, recent infection, unexplained constitutional symptoms (e.g., fever/chills).

    • Action: Immediate referral to emergency care.

  • Cauda equina syndrome

    • Red flags: saddle anesthesia, bladder/bowel dysfunction, bilateral radicular signs.

    • Action: Immediate referral to emergency care.

  • Neurological disorders

    • Red flags: upper/lower motor neuron findings, clonus.

    • Action: Refer to appropriate provider.

Orange Flags

 

Clinical Cornerstone: Orange Flags are symptoms or signs that may represent the presence of serious psychiatric disorder (e.g., major depression, major personality disorders, post-traumatic stress disorders [PTSD], substance addiction and abuse). In the event such disorders are present, referral to a psychiatric specialist would be indicated over usual care in the presence of non-major disorders such as anxiety. Screening can include:

Conduct patient assessment

Red flags present

Red flags present

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Refer to appropriate emergency or healthcare provider

Non-specific LBP or LBP with radiculopathy:

  • Education

  • Self-care

  • Exercise

  • Manual therapy

  • Medicines

  • Psychological therapy

  • Social support

  • Mind-body interventions

  • Needling therapies, electrotherapies*

  • Mobility assistive devices

  • Multicomponent biopsychosocial care

  • Topical ceyenne pepper

Additionally for LBP with radiculopathy:

  • Medical/surgical consultations

Other specific LBP:

  • Refer to appropriate emergency or healthcare provider

Major symptom/sign change

Goals not achieved

Re-evaluate

Adjust treatment and management plan or refer

References or links to primary sources

Contact information for further inquiries or feedback

carolina.cancelliere@ontariotechu.ca

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