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Low back pain - how long does it last? The normal course of pain experienced by people who visit their general practitioner

At a glance:
This paper investigates the normal course of back pain experienced by people who visit their general practitioner about their condition.
  • It is widely believed that 90% of episodes of low back pain seen in general practice resolve within one month  
  • The outcomes of episodes of low back pain in general practice were examined for a large group of patients in Manchester. The study looked at the period of time over which the patients consulted their doctor, and the time it took for them to recover fully from pain and disability
  • While 90% of subjects consulting general practitioners with low back pain stopped visiting a doctor about their symptoms within three months, most had continued pain or disability
    disability
    A condition or function that leaves a person unable to do tasks that most other people can do.
     after 12 months
  • Only 25% of the patients who consulted a general practitioner about low back pain had fully recovered 12 months later
Perspectives:
Employee
This study shows that low back pain is a common problem, which for many people can last for months or years, with an untidy pattern of grumbling symptoms. 

Pain free periods may be interrupted by more significant episodes, where the problem flares up, then settles, then flares up again.

People with back pain often expect their problem to settle quickly, and then worry when it does not improve as quickly as expected. This study tells us it is normal for it to take many months, or even a year or two, to fully recover from back pain.

Other studies show that maintaining your normal activity as far as possible, and exercising, including stretching, as advised by your doctor, helps recovery.
Employer
Low back pain is a common condition, suffered by 80% of people at some time in their lives. 90% of people who suffer from it recover, though many are likely to have a future recurrence of the problem. Where low back pain is not so acute
acute
A condition develops quickly and is often of short duration. The opposite of acute is chronic, which refers to a long term problem continuing for months to years.
 that it requires surgery, the natural course of the condition can be an untidy pattern of grumbling symptoms with periods of relative freedom from pain and disability, lasting for months or even years.

Dispelling misconceptions that workers should recover quickly from back pain can help communication and relationships at work, as fellow staff and employers can become unsupportive when the problem continues for a long period. Following the advice of health professionals and helping employees with back pain to remain at work, or return to normal duties as soon as they are able, is the best response. 
Treater
Giving patients realistic expectations about the course of their back pain symptoms is important. If a patient assumes their condition will resolve within weeks, problems continuing beyond that time will be of increasing concern to them. This study shows that back pain often continues for more than 12 months. Reassuring the patient that the pain may continue, but they should be able to return to most activities, may help to reduce worry.
Insurer
Previously, it was generally thought that nearly all incidents of back pain would resolve completely over a few months. This key study followed the progress of patients' recovery, even if they were not returning for ongoing care by their doctors. The researchers found that most patients took more than a year to fully recover from back pain.

When everyone is aware that back pain can take many months or even years to settle, we can set more realistic goals for the management of this common condition.
Original Article, Authors & Publication Details:
P. R. Croft1, G. J. Macfarlane2, A. C. Papageorgiou2, E. Thomas2, A. J. Silman2 (1998).

Outcome of low back pain in general practice: A prospective study. British Medial Journal; 316(7141): 1356-9.

1 University of Keele, School of Postgraduate Medicine, Industrial and Community Health Research Centre, Hartshill, Stoke on Trent ST4 7QB

2 ARC Epidemiology
epidemiology
The study of factors affecting the health and illness of populations. Also refers to the study of management and control of health problems.
 Research Unit, School of Epidemiology and Health Sciences, University of Manchester, Stopford Building, Manchester M13 9PT
Background, Study Objectives, How It Was Done:
The study investigated the general belief that back pain usually settles completely within 6 weeks. Earlier studies of back pain assumed that the person's condition had improved if they stopped visiting their doctor. This study followed people who had consulted their doctor about back pain, asking them about the progress of their condition whether they continued to attend the doctor about their back pain or not. 

The study was of patients attending two general practices in Manchester in the UK, and included 490 patients (203 men, 287 women) aged 18­75 years. The patients were classified into three groups, based on the medical records.
  • Those who had no further consultations about low back pain
  • Those who consulted again with back pain within three months, but not subsequently
  • Those whose further consultations about their pain extended beyond three months.
A subgroup of the patients were visited by a research nurse and interviewed within a week of their initial consultation, and then again after 3 and 12 months. They completed specific questionnaires about their level of pain and disability.
Study Findings:
During the 12 month recruitment period 490 people (203 men and 287 women) consulted doctors at the two practices at least once because of pain in the lower back. This represented about 6% of the adult patients at the practices. 

The study looked only at those who had not seen their general practitioner because of low back pain in the previous three months, and were therefore considered to be consulting a doctor about low back pain for the first time. This was the majority of the group (94%).

Women were more likely than men to consult because of low back pain, and the highest consultation rates were for those aged 45-­59.

Only 57% of the patients returned for a repeat consultation about their back pain. Of those 188 patients who did consult a doctor again, 150 (32% of the whole study group) did so only within the first three months after their first visit. The remaining 38 people (8%) had consultations or sickness certification related to low back pain for more than three months after their first consultation.

Women had a higher initial consultation rate then men, however there was no difference in the proportions who re-attended for further consultations: 80 men (42%) and 108 women (40%) had two or more. Patients 30 years or older were more than twice as likely to have repeat consultations as younger patients.

Of the 463 patients in the study who consulted with a new episode of low back pain, 218 (47%) were included in the follow up interview study, and were visited by a research nurse one to two weeks after their first consultation, and then again at three and 12 months and asked about the progress of their back pain. Of the patients available for the interviews;
  • 5/212 (2%) had completely recovered by the time of the first interview, one to two weeks after they saw a doctor about the pain
  • 39/188 (21%) had completely recovered by the three month interview
  • 42/170 (25%) had completely recovered by the 12 month interview.
At the time of the first interview, patients reported experiencing symptoms in their episode of low back pain for an average of three weeks. Most subjects who reported symptoms lasting less than two weeks had recovered by 12 months, whereas those who had episodes of longer than two weeks' duration were less likely to have recovered.
Conclusions:
The results are consistent with the interpretation that 90% of patients with low back pain in general practice will have stopped consulting a doctor about their symptoms within three months. However, most will still be experiencing low back pain and related disability one year after consultation.

This study shows that consulting a doctor is not a direct indication of the presence of pain and disability. Many patients who see a general practitioner for the first time about an episode of back pain stop consulting their doctor about it before they have fully recovered from their pain or disability.

The study concludes we should stop characterising low back pain as being either “acute' (short term), which was thought to account for most cases, or “chronic' (long term), which was thought to be rare.

Low back pain should be viewed as a long term problem with an untidy pattern of grumbling symptoms, and with periods of relative freedom from pain and disability interspersed with short term recurrences of the condition.

Research shows that by the age of 30 almost half the population will have experienced a significant episode of low back pain, and that people who have suffered an episode of low back pain are much more likely than others to experience back pain in the future. These observations simply do not fit with claims that 90% of episodes of low back pain end in complete recovery.

Finally, the study's observation that most patients continue to get some degree of pain and disability after consulting about low back pain raises an important question: Can early treatment improve rates of recovery? If so, effective treatment could help reduce the incidence of long term low back pain in the community, and the social, economic, and medical consequences that accompany it.
References:
PubMed Abstract
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