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Contact your healthcare provider promptly if: Back pain persists beyond 23 weeks despite conservative measures Pain progressively worsens rather than improving Pain significantly interferes with daily activities or sleep Systemic symptoms develop (fever, night sweats) or unintentional weight loss beyond therapy goals Pain occurs in patients with cancer history or other risk factors for metastatic disease Flank pain accompanied by urinary symptoms (possible kidney stones or infection) Clinicians should obtain a thorough history, perform physical examination, and consider laboratory evaluation (including serum lipase and liver function tests) when indicated