Gaspar Doctors of Physical Therapy Newsletter

Low Back Pain - Not As Benign As It's Sometimes Reported

Non-specific low back pain (LBP) affects eighty percent of Americans some time in their life. It's the second most common diagnosis seen in general practice. Historically, numerous clinical studies have reported that non-specific low back pain is self-limiting and has a minimal impact on lost days of work. Previously, it was also reported the re-occurrence of LBP was likely in only 25 percent of patients after the initial onset of LBP. New research in the April, 2012 issue of Spine, suggests that previous conclusions that LBP is benign, self-limiting with little impact on function are questionable.

In this study, the authors looked examined a large group of health care service workers, with no prior history of LBP, who had sought out medical care for a first episode of low back pain of up to one month in duration. Interviews were conducted at baseline, 6 and 24 months. The researchers looked at re-occurrence, global pain, and functional recovery. What the authors found was surprising.

Low Back Pain Prognosis Is Not As Good As Previously Reported

Results: Cohort respondents indicated that pain, disability, sick leave and the development of chronic pain were major issues. 605 experienced an average of almost 6/10 on a 0-10 pain rating scale, and a 15.8 out of 24 disability rating on the Roland-Morris scale. Eight percent declared sick leave, thirteen percent of 521 follow-ups reported chronic pain at six months, which increased to 19% at the two-year follow up point. Just over half had a repeat episode of LBP at 6-month follow up while 47% had a similar reoccurring bout of pain at the 2-year follow up.

This study challenges previous conclusions that low back pain prognosis is favorable for a vast majority of patients with no previous history of pain. Of course, further studies are indicated in other work populations to confirm or refute these results.

It is commonplace for patients to report previous episode of pain to physical therapists. It's also well accepted that a conservative, early and active rehabilitation program decreases recurrent episodes of pain and results in a lower overall cost of care to patients.

Given this new study and favorable results with active physical therapist guided intervention, we recommend physicians consider rapid referral for patients with mechanical, nonspecific low back pain.

Mehling, W., Gopisetty, V, et. al. The Prognosis of Acute Low Back Pain in Primary Care in the United States: A 2-Year Prospective Cohort Study. Spine, April 15, 2012 - Volume 37 - Issue 8.

Thanks from Paul Gaspar DPT

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