Prognosis of a new episode of low‐back pain in a community inception cohort

Abstract

Background Most studies investigating the prognosis of low back pain (LBP) enrol people presenting for care, rather than all people who have an episode of LBP. We aimed to describe the prognosis of an acute episode of LBP in a community inception cohort. Methods We used data from two previous studies investigating recurrence of LBP. Participants without current LBP were contacted monthly to assess if they had experienced a new episode of LBP. 366 participants reporting a new episode of LBP were included in the current study. The primary outcome was duration of the new episode of LBP. Secondary outcomes were average and worst pain during the episode and the proportion of participants seeking care. Results The median duration of the episode was 5 days (95% CI 3.99 to 6.02). The cumulative probability of recovery was 70.0% (95% CI 65.3 to 74.7) before 1 week, 86.1% (95% CI 82.6 to 89.6) before 3 weeks, 90.9% (95% CI 88.0 to 93.8) before 6 weeks, and 93.5% (95% CI 90.8 to 96.0) before 12 weeks. The mean average pain intensity was 3.7 (SD ± 1.5), and the mean worst pain intensity was 5.6 (SD ± 1.9). The proportion of patients who sought care was 39.5% (95% CI 33.9 to 46.4). Conclusions This study found most episodes of LBP recover rapidly and more quickly than typically reported for clinical populations. The worst pain during the episode was typically moderate despite the rapid recovery for most people. Approximately 40% of the participants who experienced an episode of LBP sought care. Significance This study describes the prognosis of an acute episode of LBP in a community inception cohort. This study found the majority of episodes of LBP, in community‐dwelling adults, recover rapidly (median of 5 days) and more quickly than typically reported for clinical populations. The community should be reassured about the favourable prognosis of acute LBP.

Transition from Acute to Chronic Low Back Pain in a Community-Based Cohort

“…We preliminary examined a diverse sample of community-based participants to determine the transition fro acute LBP to chronic LBP at 3 and 6 months. In contrast to a recent study of community-based participants in Australia [15], we identified a relatively high incidence of chronic LBP at 3 months following a new acute episode Interestingly, the transition rates reported in this cohort are consistent with a recent study of US patients seeking ca and potentially identify a "hidden" burden of chronic LBP among community-based participants who may not see in the first 6 months of a new LBP episode. This is important because previous studies have reported as many as 42 community-based participants do not seek care for LBP [22].…”

“…For example, a recent Australian community-based cohort study indicated that acute LBP’s prognosis is far better than in clinical populations. [15] However, the same may not be accurate in the US, given the differences between these countries (e.g., demographic makeup, sociopolitical, and healthcare characteristics). The limited US community-based studies also indicate that chronic LBP incidence is higher than previously thought (approximately 25%).…”

The clinical course of acute, subacute and persistent low back pain: a systematic review and meta-analysis

“…Our findings are consistent with similar work. In a community cohort, De Campos and colleagues 131 found that a subsequent new episode of acute low back pain resolved rapidly (about 5 d) among participants who had recently recovered from low back pain (including participants enrolled in a randomized controlled trial to prevent recurrence of low back pain). A systematic review of randomized controlled trials reported a similar pattern of improvement within the first 6 weeks and less pronounced improvement at longer-term follow-up (1 yr).…”

A Ground-Breaking Study on the Prognosis of Low Back Pain

“…So Tarcisio F. de Campos, from Macquarie University, and a group of Australian and Brazilian researchers decided to perform an inception cohort study of a community-dwelling population—of people who did not have back pain and were not seeking care at the beginning of the study. (See de Campos et al, 2023. )…”