Table 3

Presence of ‘flags’ for musculoskeletal pain

FlagFlag descriptionCases where present and common themes
Red FlagsSigns of serious pathology, for example, fracture, malignancy4.2% (95% CI ±2.3%, n=13)
History of cancer, trauma, suspicious radiograph changes and urinary disturbance
Orange FlagsPsychiatric symptoms such as depression or personality disorder42.5% (95% CI ±5.5%, n=130)
Predominantly affective disorders of anxiety and depression, but also psychosis and substance dependence
Yellow FlagsBeliefs, emotional responses, pain behaviours, for example, catastrophising, avoidance behaviours, interest in passive treatments only, etc.22.9% (95% CI ±4.7%, n=70)
Fear avoidance (refusing physiotherapy without diagnosis) and negative structural beliefs about their condition
Blue FlagsPerceptions between occupational work and health, for example, that work or employers will cause further difficulty18.0% (95% CI ±4.3%, n=55)
Predominantly disputes with employers with majority medically signed off work long-term
Black FlagsSystemic obstacles, such as legal issues8.0% (95% CI ±3.0%, n=23)
Legal proceedings relating to assaults, road traffic accidents, marriage, disability or housing