Low back pain: persistent symptoms/red flags referral

Urgency tier

• Immediate emergency assessment for suspected cauda equina, progressive motor deficit, or suspected spinal infection/epidural abscess; do not wait for routine referral workup.
• Expedited referral for progressive neurologic findings or refractory severe pain limiting function.
• Routine referral for persistent symptoms beyond expected recovery despite structured first-line care.

Minimum pre-referral workup

• Document symptom duration, pain pattern, function impact, and neurologic exam findings.
• Include prior conservative treatments and response timeline.
• Attach any imaging reports already performed with interpretation context.

Referral packet checklist

• Current diagnosis and top differential concerns.
• Medication and non-pharmacologic treatment history.
• Work impact, functional limitations, and patient goals.

Pre-referral optimization tasks

• Continue active rehabilitation plan as tolerated.
• Reinforce analgesic safety limits and return precautions.
• Ensure patient understands expected referral timelines and trigger points for urgent reassessment.

References

• Choosing Wisely Canada recommendations (opens in a new tab)

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