The course of back pain in primary care

Spine (Phila Pa 1976). 1996 Dec 15;21(24):2833-7; discussion 2838-9. doi: 10.1097/00007632-199612150-00004.


Study design: Review paper of outcome studies among primary care back pain patients.

Objectives: To determine the short-term and long-term pain and functional outcomes of patients with back pain who are seeking treatment in primary care settings.

Summary of background data: Back pain has been viewed as running either an acute or a chronic course, but most patients experience recurrent back pain. This review summarizes outcome studies in light of the episodic course of back pain.

Methods: Studies reporting pain and functional outcome data for consecutive primary care patients with back pain were reviewed.

Results: Back pain among primary care patients typically is a recurrent condition for which definitions of acute and chronic pain based on a single episode are inadequate. Because a majority of patients experience recurrences, describing only the outcome of the initial back pain episode may convey a more favorable picture of long-term outcome than warranted. For the short-term follow-up evaluation, most patients improve considerably during the first 4 weeks after seeking treatment. Sixty-six percent to 75% continue to experience at least mild back pain 1 month after seeking care. At 1 month, approximately 33% report continuing pain of at least moderate intensity, whereas 20-25% report substantial activity limitations. For the long-term follow-up (1 year or more) period, approximately 33% report intermittent or persistent pain of at least moderate intensity, one in seven continue to report back pain of severe intensity, and one in five report substantial activity limitations.

Conclusion: Results from existing studies suggest that back pain among primary care patients typically runs a recurrent course characterized by variation and change, rather than an acute, self-limiting course.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Back Pain / etiology*
  • Disability Evaluation
  • Humans
  • Longitudinal Studies
  • Pain Measurement
  • Primary Health Care*
  • Prognosis
  • Quality of Life
  • Recurrence
  • Treatment Outcome