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Outcomes in Patients With Episodes of Low Back Pain
Am Fam Physician. 1998 Sep 1;58(3):771-772.
In two separate surveys, a little more than one third of adults reported having an episode of significant low back pain over the course of one year. Low back pain is a common presenting complaint in family practice. Croft and colleagues conducted a prospective study to investigate the conventional belief that over 90 percent of such episodes resolve within one month.
All patients with low back pain presenting to two general practices during a one-year period were considered for the study. Patients were excluded if they had visited a physician because of low back pain during the previous three months, if the pain occurred only in the thoracic region of the back or if the symptoms were attributed to gynecologic or urinary conditions. The researchers reviewed the records for subsequent consultations of these patients for six months after the initial consultation and conducted interviews with a subgroup who had previously taken part in a comprehensive survey of patients at the two practices.
In general, women were found to be more likely than men to visit a physician because of low back pain. In both sexes, the highest consultation rates were seen in patients from 45 to 59 years of age. Of the 463 patients participating in the study, 275 (59 percent) did not consult a physician again after the initial visit during the six months monitored. Of the 188 patients who made return visits because of low back pain, 150 patients (32 percent) did so within three months of their initial visit. Men and women were equally likely to seek a repeat consultation, but repeat consultations were less common in patients younger than 30 years.
Approximately one half (218) of the patients who were seen with a new episode of low back pain were interviewed by nursing staff within two weeks of the initial visit and at three and 12 months thereafter. Five patients (2 percent) reported complete recovery by the first interview, 39 patients (21 percent) reported complete resolution of symptoms by three months and 42 patients reported complete response (25 percent) by 12 months.
The authors conclude that only a minority of patients with low back pain recovered within three months of the initial visit. Although most patients did not return to their physicians, only one fourth reported a full recovery one year after the initial visit. The authors attribute the difference in their study findings from those of previous studies to selection bias and equating “recovery” with no further visits to health care professionals. They also advocate that low back pain be considered a long-term chronic problem in most patients, particularly in those more than 30 years of age.
Croft PR, et al. Outcome of low back pain in general practice: a prospective study. BMJ. May 1998;316:1356–9.
Copyright © 1998 by the American Academy of Family Physicians.
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