Table 1 Three types of low-back pain to be used in patient triage

A) Non-specific back pain

   General characteristics:

- Lumbar or lumbosacral pain with no neurological involvement

- "Mechanical" pain, varying over time and with physical activity

- Patient's general health is good

B) Back pain with neurological involvement

   The patient should have one or more symptoms and signs indicating possible neurological involvement.

Symptoms

- Pain radiating below the knee, which is as intense or more intense than the back pain

- Pain often radiating to the foot or toes

- Numbness or paresthesia in the painful area

Signs

- Positive sign for radicular irritation as tested, for example, by straight leg raising

- Motor, sensitivity or reflex signs supporting nerve root involvement.

C) Back pain with suspected serious spinal pathology (red flags)

   General characteristics:

   - Violent trauma (such as a fall from height or an automobile accident)

   - Constant, progressive, non-mechanical pain

   - Thoracic or abdominal pain

   - Pain at night that is not eased by a prone position

   - History of or suspected cancer, HIV or other pathologies that can cause back pain

   - Chronic corticosteroid consumption

   - Unexplained weight loss, chills or fever

   - Significant and persistent limitation of lumbar flexion

   - Loss of feeling in the perineum (saddle anesthesia), recent onset of urinary incontinence

   The risk of a serious condition may be higher in those under 20 or over 55 years of age. Particular attention should be paid to the previously mentioned signs and symptoms in patients in these age groups.