Early diagnosis, urgent onward referral for further investigation and prompt treatment (initiation of steroid therapy, MRI, pain management, emergency radiotherapy and/or surgery).

An extensive consensus-building proces was started between physiotherapists, oncologists, palliative care specialists, a GPSI and an orthopaedic surgeon.

This credit card includes 3 key statements about MSCC

• Past medical history of cancer;
• Early diagnosis is essential (as the prognosis is severely impaired once paralysis occurs); 
• A combination of Red Flags increases suspicion (the more red flags, the higher the risk and greater urgency).

Moreover, it features signposting to key sources of additional information (see below) and a user-friendly list of Red Flags which has been developed into an 8-item Red Flag acronym:

R eferred pain that is multi-segmental or band like
E scalating pain which is poorly responsive to treatment (incl medication)
D ifferent character or site to previous symptoms

F unny feelings, odd sensations or heavy legs (multi-segmental)
L ying flat increases back pain
A gonising pain causing anguish or despair
G ait disturbance, unsteadiness, especially on stairs (not just a limp)
S leep grossly disturbed due to pain being worse at night