Common Symptoms

Low Back Pain

The vast majority of low back pain in the outpatient setting is mechanical and self-limited. The clinician's job is to identify the small subset with cauda equina syndrome, spinal epidural abscess, vertebral fracture, cord compression from metastatic disease, ruptured AAA, or pyelonephritis — and to avoid unnecessary imaging in everyone else. This page covers red flags (saddle anesthesia, urinary retention or incontinence, fecal incontinence, fever + IV drug use or recent procedure, age > 70 or chronic steroids, history of cancer, progressive neuro deficit, night pain, weight loss), the minimum safe first-pass workup including a complete neuro and rectal exam when warranted, conservative outpatient management with NSAIDs and early mobilization, escalation criteria, documentation patterns that protect you, and clear return precautions. Written for NPs, PAs, and MDs in outpatient practice.

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