It appears that exercise is the best prescription for chronic low back pain. Even patient education alone without exercise is useless (a case of faith without works is dead?), as are lumbar support and shoe insoles.
Low back pain is arguably the most common musculoskeletal complaint encountered in general practice. As such, it is easy to miss something sinister till it's too late.
Red flags are alarming symptoms that suggest that it could be something sinister. While there is no universal agreement on what they are, it is important to stay vigilant of the more common ones which have been flagged.
As a frontline family doctor seeing tonnes of low back pain on a daily basis, one of the potential "red flags" not to be missed is inflammatory back pain. This may signify spondyloarthritis, infection or malignancy.
Early referral for definitive diagnosis and treatment may prevent functional deterioration and permanent disability.
As a rheumatologist, I find this study particularly disconcerting: 10% of Fibromyalgia patients fulfil ASAS criteria for Axial Spondyloarthritis, while 25% show radiographic features suggestive of AS.
Granted, it's a small study of 88 patients. But if the results are accurate and representative, we may possibly be misdiagnosing a good proportion of early/mild AS as FM, possibly delaying diagnosis of a "red flag" condition. Conversely, if the results are non-representative, then we may end up over-investigating FM (HLA-B27, MRI), or worse, treating them inappropriately with expensive and potentially hazardous medication (anti-TNFs).