Is It Time to Rethink the Typical Course of Low Back Pain?

• Published in: PM & R 2012-06, Vol.4 (6), p.394-401
• Main Authors: Donelson, Ronald, MD, MS, McIntosh, Greg, MSc, Hall, Hamilton, MD, FRCSC
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Age of Onset; Aged; Aged, 80 and over; Cross-Sectional Studies; Disease Progression; Education, Medical, Continuing; Europe; Female; Follow-Up Studies; Humans; Low Back Pain - epidemiology; Low Back Pain - physiopathology; Low Back Pain - rehabilitation; Male; Middle Aged; North America; Physical Medicine and Rehabilitation; Recurrence; Risk Assessment; Severity of Illness Index; Sex Factors; Surveys and Questionnaires; Time Factors; Treatment Outcome; Young Adult
• ISSN: 1934-1482; 1934-1563
• DOI: 10.1016/j.pmrj.2011.10.015

Objective To determine the frequency and the characteristics of low back pain (LBP) recurrences. The research questions were as follows: (1) Are LBP recurrences common? (2) Do episodes worsen with multiple recurrences? (3) Does pain change location in any recognizable pattern during an episode? Design Single-page self-administered questionnaire. Setting Thirty clinical practices (primary care, physical therapy, chiropractic, and surgical spine) in North America and Europe. Patients A convenience sample of 589 respondents with LBP. There were no exclusions based on type of LBP, history of onset, or comorbidities. Methods The survey was distributed during patients' assessment or initial treatment at their respective clinics. The survey queried the following: (1) the severity of original versus most recent episodes based on the following: pain intensity, interference with leisure and work activities, duration of episodes, and most distal extent of pain; and (2) changes in pain location within episodes. Results In response to research question 1, a previous episode was reported by 73%; of those, 66.1% reported their first episode lasted ≤3 months, 54% reported ≥10 episodes, and 19.4% reported >50 episodes. In response to research question 2, of those with recurrences, 61.1% reported that at least one of the survey domains was worse in recent episodes ( P < .01) and only 36.9% reported that they were better; 20.5% were worse in all domains, whereas 8.6% were better or the same. In response to research question 3, the pain location changed during the episode in 75.6%; of these, 63.2% reported that their pain first spread distally before retreating proximally during recovery; there was a strong trend toward those reporting worsening episodes also reporting proximal-to-distal-to-proximal changes in pain location during their episodes ( r = 0.132, P < .06). Conclusion Recurrent LBP episodes were common and numerous. Recurrences often worsened over time. It seems inappropriate to characterize the typical course of LBP as benign and favorable.