SGBP Final 4

Yellow flags

indicate

psychosocial

problems not

related to the back

pain at all

Management of back pain: Active Rehabilitation

Just as we discussed for Step One Measures, there are three possible outcomes when
using Step Two Measures:

1. The back pain resolves completely


2. The back pain is much less but has not gone. In such a case, continue with the
   same measures for a further period of four weeks till the pain disappears
   completely


3. There is no improvement after two weeks. If this happens, look again for red
   flags. If they are present, consider surgical treatment. If they are absent, the
   orthopod needs to look for any “yellow flags.” Yellow flags indicate that there
   are deep seated problems not related to the back pain at all but which prevent the
   person from getting better.

Yellow flags may be noted by the physician at any point during
the management of back pain. These are psychosocial factors
that are associated with an increased likelihood of developing
chronic back pain:

1. Activity avoidance due to fear – where the person fears
   that activity will cause permanent damage


2. Reliance on passive treatments rather than active participation and self-care


3. Disputed compensation claims/ financial problems


4. Psychological distress and/ or depression


5. Job dissatisfaction


6. Work related litigation related to the back pain


7. Signs and symptoms not consistent with the severity of pain expressed


8. Family/ social problems leading to emotional stress which is somatized as back
   pain