Acute low back pain is marked by variability: An internet-based pilot study

• Published in: BMC musculoskeletal disorders 2011-10, Vol.12 (1), p.220-220, Article 220
• Main Authors: Suri, Pradeep, Rainville, James, Fitzmaurice, Garrett M, Katz, Jeffrey N, Jamison, Robert N, Martha, Julia, Hartigan, Carol, Limke, Janet, Jouve, Cristin, Hunter, David J
• Format: Article
• Language: English
• Subjects: Acquisitions & mergers; Acute Pain - pathology; Acute Pain - physiopathology; Back pain; Backache; Bone surgery; Care and treatment; Clinical medicine; Cohort Studies; Data collection; Data Collection - methods; Diagnosis; Disability Evaluation; Female; Health education; Humans; Internet; Low Back Pain - pathology; Low Back Pain - physiopathology; Male; Middle Aged; Musculoskeletal diseases; Pain management; Pain Measurement; Pilot Projects; Questionnaires; Studies; Surveys and Questionnaires; Womens health
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/1471-2474-12-220

Pain variability in acute LBP has received limited study. The objectives of this pilot study were to characterize fluctuations in pain during acute LBP, to determine whether self-reported 'flares' of pain represent discrete periods of increased pain intensity, and to examine whether the frequency of flares was associated with back-related disability outcomes. We conducted a cohort study of acute LBP patients utilizing frequent serial assessments and Internet-based data collection. Adults with acute LBP (lasting ≤3 months) completed questionnaires at the time of seeking care, and at both 3-day and 1-week intervals, for 6 weeks. Back pain was measured using a numerical pain rating scale (NPRS), and disability was measured using the Oswestry Disability Index (ODI). A pain flare was defined as 'a period of increased pain lasting at least 2 hours, when your pain intensity is distinctly worse than it has been recently'. We used mixed-effects linear regression to model longitudinal changes in pain intensity, and multivariate linear regression to model associations between flare frequency and disability outcomes. 42 of 47 participants (89%) reported pain flares, and the average number of discrete flare periods per patient was 3.5 over 6 weeks of follow-up. More than half of flares were less than 4 hours in duration, and about 75% of flares were less than one day in duration. A model with a quadratic trend for time best characterized improvements in pain. Pain decreased rapidly during the first 14 days after seeking care, and leveled off after about 28 days. Patients who reported a pain flare experienced an almost 3-point greater current NPRS than those not reporting a flare (mean difference [SD] 2.70 [0.11]; p < 0.0001). Higher flare frequency was independently associated with a higher final ODI score (ß [SE} 0.28 (0.08); p = 0.002). Acute LBP is characterized by variability. Patients with acute LBP report multiple distinct flares of pain, which correspond to discrete increases in pain intensity. A higher flare frequency is associated with worse disability outcomes.