Predicting the Future of Low Back Pain
Low back pain (LBP) is unpredictable. It can go away within a few weeks, or it can become an ongoing, lifelong problem. People with LBP (and their doctors) would love to have a crystal ball to show them what to expect for their back in the future.
These authors don't supply a crystal ball. But they did look for ways to predict which patients with LBP will have long-term problems. They looked at records of more than 1200 patients with LBP to see if there were common factors in those whose pain became chronic. They interviewed patients six times over 22 months.
Patients answered questions about their pain levels, medical care, work status, and ability to do certain tasks. Patients who were still having symptoms after three months were considered to have chronic LBP. Patients who had symptoms throughout the 22 months were considered to have unremitting LBP.
The authors found that the 96 (7.7%) patients who had chronic LBP were more likely to be nonwhite and in a lower income bracket when they developed LBP. They were more disabled by their back pain and more likely to have pain that affected their legs (sciatica). The authors also found that the prognosis for these patients was poor. At 22 months, only 16% had no back symptoms. And 67% of patients still had symptoms that limited their ability to function normally.
Surprisingly, the authors found that patients with the worst LBP often got the least medical care. Of the 59 patients categorized with unremitting LBP, only 58% sought health care for their back problems from month three to month 22.
The authors conclude that, in their study, only two variables seemed to be of much use in predicting chronic LBP. Patients with less ability to function on their first doctor visit were especially likely to develop chronic LBP. And patients' functional ability at the four-week mark was also strongly related to having future problems with chronic LBP.Â
More research is needed to know exactly how these results can be used. And though it's no crystal ball, this study can help doctors give their low-back patients an idea of what to expect in the future.
Timothy S. Carey, MD, MPH, et al. Beyond the Good Prognosis: Examination of an Inception Cohort of Patients With Chronic Low Back Pain. In Spine. January 1, 2000. Vol. 25. No. 1. Pp. 115-120.