I had a series of bad days with low back pain -- couldn't walk, couldn't work, could hardly get out of bed. I was so glad when that cleared up, I vowed I would do whatever it takes to keep from going through that again. Before I could turn around, it hit me again. My orthopedic surgeon thinks I never really recovered from the first episode. How can they tell that?
It can be difficult to know when an episode of back pain is just a continuation of the last bout or an actual recurrence. Defining recurrence is the topic of a recent study from Australia. The authors looked at the different ways researchers define recurrence. When trying to figure out which treatment works best for low back pain, the concept of recurrence becomes an important measuring stick. According to the authors of this paper, a true recurrence really means the patient recovered fully from the first episode. The new symptoms are truly considered a separate incident. But the gray area comes when trying to say just when one episode ended and a new episode began. And there's some question as to whether features such as pain intensity, duration, or frequency should factor into the definition. For example, does the pain have to last more than one hour to be considered a recurrence? Or two hours? Half a day or longer? Is there a minimum level of intensity that qualifies? Does it have to be at least five on a scale from zero (no pain) to 10 (most pain)? Does the location of the pain matter in the definition? Maybe when back pain is severe enough to limit activities or cause the person to seek treatment, then the incident becomes an episode. In the end, it was recommended by the authors that a level two pain intensity on a scale from zero to 10 lasting at least 24 hours signals a new episode of low back pain. And the pain must occur after at least 30 days pain free from the last bout of back pain. This last parameter (i.e., pain-free for at least one month) represents the working definition of recovery. Pain-related disability (e.g., pain severe enough to limit activities for more than one day) should be part of the complete definition of an episode of low back pain.