Understanding the Clinical Course of Low Back Pain

Male chiropractor assessing a male patient's back

Something we discuss with chiropractic patients every day!

Low back pain is a leading cause of disability worldwide with the most common type being ‘nonspecific’. The pillars regarding the management of low back pain are education and reassurance, nonpharmacological treatments and analgesic medications to reduce pain and disability.

The literature suggests that the clinical course of low back pain is generally favourable. However, recurrence is common and persistent symptoms are the norm for many patients. Two prior systematic reviews have shown that although many patients recover within the first month, low levels of pain and disability often persist.

In 2012, the authors of this review conducted a meta-analysis and concluded that patients with acute or persistent low back pain usually experience a positive trajectory, with most showing substantial improvement in pain and disability within the first six weeks.

However, within that review, sub-acute low back pain (defined as pain for 6-12 weeks), was combined within the persistent low back pain group, which typically consists of individuals experiencing back pain for more than 12 weeks. As a result, the persistent back pain group may have demonstrated more favourable outcomes. Furthermore, the 2012 review did not consider different populations or confounding factors and did not assess the certainty of evidence or evaluate study attrition when assessing risk of bias.

Therefore, developing a better understanding of the clinical course of low back pain across different pain durations and populations is important. The authors updated the previous meta-analysis to understand the clinical course of acute low back pain, which was defined as less than six weeks, subacute low back pain which was defined as 6 to 12 weeks, and persistent low back pain which was defined as 12 weeks to one year, taking into account age and neuropathic spine related leg pain.

RESEARCH REVIEW: Understanding the Clinical Course of Low Back Pain

This paper was published in the Canadian Medical Association Journal (2024)

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