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The New Zealand Guidelines Group (NZGG) have a set of guidelines on the management of low back pain. The guidelines aim to differentiate between nociceptive and neuropathic pain to facilitate appropriate pain management and the prevention of chronic pain and disability14. They are based on assessment of risk signified by either “Red Flags” or “Yellow Flags”.
“Red Flags” and/or abnormal tests represent physical and psychological risk factors that indicate the need to consider referral to an appropriate specialist or at least further investigation14. Certain Red Flags, such as severe pain at night or weight loss, should lead to full investigation and/or referral being considered, even if tests are normal14.
Red Flags for potentially serious conditions include14:
- Significant trauma
- Weight loss
- History of cancer
- Fever
- Intravenous drug use
- Steroid use
- Patient over 50 years
- Severe, unremitting night time pain
- Pain that gets worse when lying down.
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