Low back pain (LBP) is an extremely common health condition; It is the number one cause of disability in most countries according to the Global Burden of Disease studies . In the adult population, around 39% are expected to experience low back pain in a given year. Despite the high prevalence of low back pain, existing literature suggests that the natural course of an episode of low back pain is usually favorable .
A systematic review on the prognosis of acute low back pain (15 cohort studies and 3316 participants) provides strong evidence that most episodes of acute low back pain improve substantially within 6 weeks and, by 12 weeks, most participants they are recovering. The median duration of an episode of low back pain varies across studies, but is commonly reported to be 2 to 8 weeks . Different definitions of recovery from an episode and different populations included likely contribute to this variability.
However, the vast majority of studies investigating the prognosis of an episode of acute low back pain, including the studies in the Systematic Review of Prognosis, enroll people who present for care. The prognosis of care-seeking populations may not represent the prognosis of people in the community who have an episode of low back pain, many of whom do not seek care. The prognosis of an episode of low back pain for people in the community may be more favorable than in the care-seeking subgroup; however, little data is available from community populations. High-quality information on the prognosis of people in the community will improve the understanding of low back pain and can be used to inform public health recommendations and campaigns for people in the community experiencing low back pain. Several current LBP guidelines recommend self-management as the initial step in the management of LBP.
There is a paucity of high-quality initial cohort studies investigating the course of an episode of low back pain in community-dwelling adults (i.e., not drawn from a care-seeking population). Therefore, the aim of this study was to describe the prognosis, pain intensity, and proportion of participants seeking care after an acute episode of low back pain in a community-based cohort.
Background
Most studies investigating the prognosis of low back pain (LBP) enroll people who present for care, rather than everyone who has an episode of LBP. Our objective was to describe the prognosis of an acute episode of low back pain in a community-based cohort.
Methods
We used data from two previous studies that investigated recurrence of low back pain. Participants without current low back pain were contacted monthly to assess whether they had experienced a new episode of low back pain. The current study included 366 participants who reported a new episode of low back pain. The primary outcome was the duration of the new episode of low back pain. Secondary outcomes were average and worst pain during the episode and the proportion of participants who sought care.
Results
The median episode duration was 5 days (95% CI: 3.99 to 6.02). The cumulative probability of recovery was 70.0% (95% CI 65.3 to 74.7) before 1 week, 86.1% (95% CI 82.6 to 89.6) before 3 weeks, 90 .9% (95% CI 88.0 to 93.8) before 6 weeks and 93.5% (95% CI 90.8 to 96.0) before 12 weeks.
The mean intensity of the average pain was 3.7 (SD ± 1.5), and the mean intensity of the worst pain was 5.6 (SD ± 1.9). The proportion of patients seeking care was 39.5% (95% CI: 33.9 to 46.4).
Conclusions This study found that most low back pain episodes recover quickly and faster than typically reported for clinical populations. The worst pain during the episode was typically moderate despite the rapid recovery of most people. Approximately 40% of participants who experienced an episode of low back pain sought care. Meaning This study describes the prognosis of an acute episode of low back pain in a community-based cohort. This study found that most episodes of low back pain, in community-dwelling adults, recover quickly (median 5 days ) and faster than typically reported for clinical populations. The community should be reassured about the favorable prognosis of acute low back pain. |
Key findings
This study found that most people in the community who have episodes of low back pain recover quickly and much faster than is typically reported for care-seeking episodes. The median duration of a community episode of low back pain was only 5 days, with 70% of episodes recovered before 1 week and 91% before 6 weeks. Despite typically rapid recovery, the worst pain intensity during the episode was moderate on average, and about 40% of episodes resulted in seeking care.
Meaning and implications of the findings
The main implication of our study is that, given the short duration of most LBP episodes, the community should be reassured about the favorable prognosis of LBP and encouraged to try to self-manage most episodes by seeking care. only if the episode does not resolve quickly or if the episode is severe. Currently, there are many unhelpful beliefs about low back pain in the general community that are inconsistent with the current evidence on low back pain, including our findings. Previous media campaigns have aimed to change community attitudes towards low back pain to be more in line with current evidence, with mixed results. Our finding that most episodes recover quickly provides more compelling and simple evidence that could improve campaigns to change community attitudes toward LBP.
Despite the overall good prognosis and rapid recovery of many people who experienced an episode of low back pain, we found that about 40% of participants still sought care for the episode. This paradox suggests that recommendations to self-manage most episodes of low back pain before seeking care may not be well understood in the community or may not be acceptable to some people with low back pain. More research is required to explore why patients seek care and whether a better community understanding of the positive prognosis of low back pain, identified in this study, can help reassure patients to self-manage and therefore Therefore, they reduce attention seeking.
Our findings also have implications for clinicians managing low back pain. Our findings further support international guideline recommendations to reassure patients about the favorable prognosis of an episode of low back pain. However, as our findings relate directly to people in the community, they are particularly relevant to the advice that clinicians should provide about future episodes when discharging patients. Patients should be warned that, although recurrences are common , the vast majority will recover quickly. Ideally, clinicians would provide patients with the skills and confidence to self-manage most future episodes of low back pain. Our previous trial investigating a brief prevention intervention (two sessions of exercise and McKenzie education) found that while the intervention did not prevent recurrences, it did appear to substantially reduce care-seeking when an episode occurred.
