A new study finds that treatment for acute back pain may decrease or remove the complaint of pain, but additional and/or other treatment may be required for the chronic, longer term disability that develops in the 65-90% of population that develops acute low back pain.

Low Back Pain Eases but Doesn't Vanish

 

By Rita Baron-Faust, Contributing Writer, MedPage TodayPublished: May 14, 2012

Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Symptoms of acute and persistent low back pain improved significantly in the first 6 weeks after treatment, but even at 1 year there was lingering chronic pain and disability, a major meta-analysis by Australian and Brazilian researchers found.

Mean pain scores (52 out of a maximum of 100, 95% CI 48 to 57) at baseline were reduced by almost half after 6 weeks (12 out of 100, 95% CI 9 to 15) but pain lingered for months, the researchers reported online in CMAJ. The study encompassed data from prospective cohort studies conducted among more than 11,000 people in a dozen countries.

Outcomes were found to be similar across all cohorts, with improvement gradually slowing and "even at 1 year, patients had low to moderate levels of pain and disability," wrote Christopher G. Maher, PhD, of the University of Sydney, and colleagues.

While the data did not include the exact nature of the back pain nor the treatments, "the important conclusion that can be drawn from the data is that much of the apparent benefits of any treatment for low back pain are likely to be unrelated to the effects of specific interventions," wrote Rachelle Buchbinder, MBBS, PhD, of Monash University in Malvern, in an accompanying commentary.

About 80-90% of the population gets l0w back pain at some point in time and about 25% would report having back pain in the past week, Buchbinder noted in an e-mail to MedPage Today.

Current treatments are aimed at symptom relief and "we are not going to get more effective treatments until we better understand the pathoanatomical basis of back pain," Maher said in an email interview. 

Recovery was measured in 19 (56.6%) of the included inception cohorts (meaning the patients were enrolled when the episode of low back pain was first reported). The majority of acute back pain patients had recovered by 12 weeks. Among those with persistent low back pain, less than half had recovered by one year, the investigators said.

The pooled estimates of the clinical course of pain and disability were determined with mixed linear models. Acute low back pain cohorts were defined as those with a mean or median pain duration of less than 6 weeks; persistent low back pain was defined as pain duration of more than 6 weeks at study entry.

"The clinical course of pain and disability in the acute pain cohorts was similar and the difference not statistically different (p=0.20). However, the clinical course of pain was more favorable than the clinical course of disability in the persistent pain cohorts (p=0.002)," Maher's team reported.

The mean reduction in pain and disability scores within the first month was 58%.

It is difficult to prevent low back pain and, while a minority of people become disabled by their pain, the idea "that disability, rather than low back pain, persists is an important pointer for improving our interventions," Buchbinder noted in her commentary.

Many patients are getting out-of-date treatments rather than treatments that are known to be effective, Maher remarked in his email to MedPage Today.

Both authors concluded that back pain, like other health problems, should now be regarded as a chronic and long-term, and that patients should be better educated about its nature and the likelihood of recurrence.

"Back pain should be considered as a chronic recurring condition which means that we should reconsider how we manage it. A one-off visit when it (the pain) is bad is not likely to provide the best outcome," said Maher.

There was no specific funding for this study.
Christopher Maher is supported by the Australia Research Council. Co-authors reported support from Australia's National Health and Medical Research Council, the University of Sydney, and Fundação de Amparo a Pesquisa do Estado de São Paulo, Brazil.

Primary source: CMAJ
Source reference:
Costa OP, et al "The prognosis of acute and persistant low-back pain: A meta-analysis" CAMJ 2012; DOI: 10.1503/cmaj.111271.

Additional source: CMAJ
Source reference:
Buchbinder R, Underwood M "Progosis in people with back pain" CMAJ 2012; DOI: 10.1503/cmaj.120627.