Quick Reference Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain

Differentiate acute, recurrent, and chronic low back pain

Acute low back problems: activity intolerance due to lower back or back and leg symptoms lasting less than three months.

Chronic low back problems: activity intolerance due to lower back or back and leg symptoms lasting more than three months.

Recurrent low back problems: episodes of acute low back problems lasting less than three months duration but recurring after a period of time without low back symptoms sufficient to restrict activity or function.

Key goal
To identify risk factors that increase the probability of long-term disability and work loss with the associated suffering and negative effects on patients, their families, and society. This assessment can be used to target effective early management and prevent the onset of these problems.

The acute pain screening questionnaire
Useful for quickly screening large numbers. Interpret the results in conjunction with the history and clinical presentation. Be aware of, and take into account, reading difficulties and different cultural backgrounds.

Clinical assessment
There is good agreement that the following factors are important, and consistently predict poor outcomes:

• presence of a belief that back pain is harmful or potentially severely disabling
• fear-avoidance behaviour and reduced activity levels
• tendency to low mood and withdrawal from social interaction
• an expectation of passive treatment(s) rather than than a belief that active participation will help

Suggested questions (to be phrased in your own style)

• Have you had time off work in the past with back pain!
• What do you understand is the cause of your back pain?
• What are you expecting will help you?
• How is your employer responding to your back pain? Your co-workers? Your family?
• What are you doing to cope with back pain?
• Do you think that you will return to work? When?

This Quick Reference Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain is to be used in conjunction with the full document. You are strongly advised to read that first.