Low back pain is a significant cause of disability globally and a costly problem, with healthcare spending increasing every year. Physical causation is generally recognized, but behavioral and emotional roots are also recognized. Management includes pain reduction through education, reassurance, non-pharmacological treatments (e.g. physiotherapy, magnetic therapy, psychotherapy where appropriate), analgesic drugs and timely reviews. Although the clinical course is generally favorable, recurrence is common and pain persists in many patients. In the current study, the researchers updated their previous meta-analysis by evaluating the clinical trajectories of low back pain of acute, subacute, and persistent nature.
The team searched the dedicated databases CINAHL, MEDLINE and Embase between 2011 and January 2023. They also searched the references of the included studies to identify additional documents. The research analyzed prospective cohort studies published in peer-reviewed journals reporting on individuals with acute (
Studies reported results for pain intensity (such as visual analog scales), disability (self-report of physical functioning, such as the Roland Morris Disability Questionnaire), or measures of global recovery. The researchers excluded studies that included individuals with low back pain for ≥ 12.0 months. We also excluded retrospective cohort studies, interventional or experimental studies, studies including pregnant women, mixed populations (including individuals with neck pain), individuals with comorbidities such as osteoarthritis, and studies without longitudinal follow-ups. The team described low back pain as pain or discomfort felt below the costal margins and above the lower gluteal folds, with or without spine-related neuropathic leg pain.
The team analyzed 28,641 documents, analyzing 23,695 abstracts and 377 full texts. After assessing eligibility, they selected 95 records for qualitative review (60 cohorts) and quantitative research (47 cohorts). The aggregated data included 9,224 individuals with pain assessments, 8,957 with disability assessments, and 13,145 with global recovery outcomes. Among individuals with acute back pain, the mean values of pain scores with the corrected onset time were 56, 26, 22, and 21 at week 0, week 6, week 26, and week 52, respectively (level certainty of evidence moderate). Among individuals with subacute pain, the mean values of pain scores in the corresponding weeks were 63, 29, 29 and 31 (moderate level certainty of evidence).
Among those with persistent low back pain, mean pain scores were 56, 48, 43, and 40, respectively (very low level of certainty of evidence). For disability, the clinical trajectory was marginally better than that for pain. Recovery outcomes revealed significant heterogeneity in recovery definition and follow-up. Patients with acute pain experienced a significant initial reduction in disability, followed by a persistent decrease over time. Subacute patients showed a similar trend but with smaller reductions in disability scores. Individuals with prolonged pain showed greater variability in trajectory and persistent moderate disability over time.
Participants with acute low back pain had a more favorable disability outcome than individuals with subacute pain. Overall, the study results showed that most individuals with acute and subacute low back pain improve within six weeks, but may continue to experience ongoing disability and pain. The clinical course in the chronic pain group was much less favorable than in the other groups. The United Nations recently recognized that low back pain is a leading cause of disability among individuals aged 60 years and older, leading to significant disability, as well as large economic and social costs. Furthermore, the global population of adults aged 60 and over is estimated to double by 2050.
It is therefore of fundamental importance to identify risk factors in older adults so that adequate prevention and treatment strategies can be developed and implemented for those at high risk. individuals. Unlike what was said above, underlining the only true physical causation, it must not be forgotten that the framework of causal factors can be very broad, ranging from rheumatological causes (arthrosis, spondyloarthritis and autoimmune causes) to neurological-psychiatric ones ( depressive syndromes, fibromyalgia, restless legs syndrome, etc.) up to true postural ones, both organic and due to a spoiled lifestyle. Finding the root of this condition, in addition to the correct therapeutic intervention, would be extremely useful not only for the quality of life of those affected, but also for alleviating the burden on the health and work systems of nations.
By Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.
Scientific publications
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Alcon C et al. Pain Res Manag. 2023 Sep; 2023:5851450.
Ma J et al. BMC Musculoskelet Disord. 2022; 23(1):1050.
Ng JY et al. J Complement Integr Med. 2021; 20(1):47-80.