Is it time to rethink the typical course of low back pain?

PM R. 2012 Jun;4(6):394-401; quiz 400. doi: 10.1016/j.pmrj.2011.10.015. Epub 2012 Mar 3.


Objective: To determine the frequency and the characteristics of low back pain (LBP) recurrences. The research questions were as follows: (1) Are LBP recurrences common? (2) Do episodes worsen with multiple recurrences? (3) Does pain change location in any recognizable pattern during an episode?

Design: Single-page self-administered questionnaire.

Setting: Thirty clinical practices (primary care, physical therapy, chiropractic, and surgical spine) in North America and Europe.

Patients: A convenience sample of 589 respondents with LBP. There were no exclusions based on type of LBP, history of onset, or comorbidities.

Methods: The survey was distributed during patients' assessment or initial treatment at their respective clinics. The survey queried the following: (1) the severity of original versus most recent episodes based on the following: pain intensity, interference with leisure and work activities, duration of episodes, and most distal extent of pain; and (2) changes in pain location within episodes.

Results: In response to research question 1, a previous episode was reported by 73%; of those, 66.1% reported their first episode lasted ≤3 months, 54% reported ≥10 episodes, and 19.4% reported >50 episodes. In response to research question 2, of those with recurrences, 61.1% reported that at least one of the survey domains was worse in recent episodes (P < .01) and only 36.9% reported that they were better; 20.5% were worse in all domains, whereas 8.6% were better or the same. In response to research question 3, the pain location changed during the episode in 75.6%; of these, 63.2% reported that their pain first spread distally before retreating proximally during recovery; there was a strong trend toward those reporting worsening episodes also reporting proximal-to-distal-to-proximal changes in pain location during their episodes (r = 0.132, P < .06).

Conclusion: Recurrent LBP episodes were common and numerous. Recurrences often worsened over time. It seems inappropriate to characterize the typical course of LBP as benign and favorable.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Age of Onset
  • Aged
  • Aged, 80 and over
  • Cross-Sectional Studies
  • Disease Progression
  • Education, Medical, Continuing
  • Europe
  • Female
  • Follow-Up Studies
  • Humans
  • Low Back Pain / epidemiology
  • Low Back Pain / physiopathology*
  • Low Back Pain / rehabilitation*
  • Male
  • Middle Aged
  • North America
  • Recurrence
  • Risk Assessment
  • Severity of Illness Index
  • Sex Factors
  • Surveys and Questionnaires*
  • Time Factors
  • Treatment Outcome
  • Young Adult