Physio Blog

Worried About Your Pain? – Red Flags to Look Out For

Throughout our lifetime we will all experience pain at some point. We will have periods of time when we might get ill and feel horrible in ourselves. Pain or illness can be upsetting and make us feel rubbish. Usually this will pass within a short time span and we can then return to our usual activities, quickly forgetting how horrible we felt just a few weeks before. Sometimes the pain is severe, excruciating, horrible; it might catch you breath, take all your attention and keep you from sleeping at night. This might be the case with a broken bone or if you have conditions such as kidney stones or appendicitis. still, with conditions such as these the pain lessens as you recover and the correct treatment and healing can take place. What is more concerning is the pain that lasts and lasts or even gets worse with time.

What is a Red Flag in Medical Terms?

Back PainWhite 3D Character in Front of a Big Red Question Mark Red Flag Waving in the Wind on Pole







The term red flag is used in medical care to describe the set of symptoms or clinical signs that could mean a sinister pathology is present. This might be cancer, fractures or broken bones and infections. These conditions need to be identified as early as possible to ensure treatment can be effective before the disease causes irreversible damage and harm.

What Are The Warning Signs For Having a Red Flag Condition?

A large number of research projects have looked to identify which ones are most reliable at telling us something more sinister is going on. The evidence suggests that it is not very reliable to identify just one of these signs or symptoms and then assume a sinister pathology. It is the combination of signs that makes a stronger case for correct diagnosis. A good analogy is to think about a criminal trial. You would be hard pushed to convince a jury that the person on trial is 100% guilty with just one piece of evidence against them but if you had multiple pieces of convincing evidence then the jury will have far more confidence that they have the right person and can convict them of the crime they committed with confidence that they have the right person. More positive signs that we can rely on equals more chance of the diagnosis being correct.

What are some more examples?

This is due to the complexity of the human body and its processes. Many conditions share signs and symptoms with other conditions. A good example is low back pain. A person may be suffering from simple mechanical low back ache but we know that severe, unremitting one sided low back pain can be a symptom of kidney stones too. In an elderly lady with a history of cancer, low bone density and a recent sudden onset of severe, unchanging back pain that is keeping her awake at night we might consider a diagnosis of vertebral fracture and possibly metastatic fracture (a condition where the bones of the back are injured because they are weakened by invading cancer of the bone). Similar symptoms but different combinations in different scenarios lead to a different conclusion.

What red flags should I look out for?

Red flags refer in the main to the identification of serious pathology including cancer, fractures and infections. Some of these agreed red flags include:

  • severe pain
  • worsening pain or constant pain
  • night pain that wakes you from your sleep
  • significant unexplained weight loss
  • trauma
  • severe injury
  • pins and needles in both legs
  • numbness in both legs
  • significant loss of strength in both limbs
  • inability to pass urine
  • inability to feel when going to the toilet around your genital area
  • loss of control when passing stools.

The age of the person with the symptoms makes a big difference to the likelihood of serious diagnosis as we know that in combination with the other signs mentioned above, people who are younger than 20 or older than 55 years of age are more likely to have a more serious diagnosis. A previous history of cancer alongside these other points also increases your likelihood of serious diagnosis.

What shall I do if I am worried?

Our advice to you is clear. If you develop a significant pain and you have any of the signs mentioned above, have a chat with your GP about them at the earliest opportunity. Most of the time it will be nothing serious and the GP can reassure you. It is not the individual signs that are important, it is clinically reasoning the whole picture and person and deciding if the combination of symptoms is serious enough to warrant further investigation. Be health conscious and monitor your symptoms or get advice from a physiotherapist or your GP.

Leanne Plenge
Chartered Physiotherapist
Physiocomestoyou Ltd