Radiating low back pain in general practice: Incidence, prevalence, diagnosis, and long-term clinical course of illness

Abstract

Objective. The aim of this study was to calculate the incidence and prevalence of radiating low back pain, to explore the long-term clinical course of radiating low back pain including the influence of radiculopathy (in a subsample of the study population) and non-radiating low back pain thereon, and to describe general practitioners’ (GPs’) treatment strategies for radiating low back pain. Design. A historic prospective cohort study. Setting. Dutch general practice. Subjects. Patients over 18 years of age with a first episode of radiating low back pain, registered by the ICPC code L86. Main outcome measures. Incidence and prevalence, clinical course of illness, initial diagnoses established by the GPs, and treatment strategies. Results. Mean incidence was 9.4 and mean prevalence was 17.2 per 1000 person years. In total, 390 patients had 1193 contacts with their GPs; 50% had only one contact with their GP. Consultation rates were higher in patients with a history of non-radiating low back pain and in patients with a diagnosis of radiculopathy in the first five years. In this study's subsample of 103 patients, L86 episodes represented radiculopathy in 50% of cases. Medication was prescribed to 64% of patients, mostly NSAIDs. Some 53% of patients were referred, mainly to physiotherapists and neurologists; 9% of patients underwent surgery. Conclusion. Watchful waiting seems to be sufficient general practice care in most cases of radiating low back pain. Further research should be focused on clarifying the relationship between radicular radiating low back pain, non-radicular radiating low back pain, and non-radiating low back pain.

Diagnostic triage for low back pain: a practical approach for primary care

“…Definitions seldom match the highly variable manifestations seen in clinical practice 17 . ‐ 20 For this reason, distinctive clusters of characteristic history cues and positive clinical examination signs, particularly the neurological assessment, provide a guide to diagnose radicular syndrome and to differentiate the subsets of this category, which is essential for clinical utility of the diagnostic triage (Box 3).…”

“… Radicular pain: in primary care, LBP‐related leg pain is common with about 60% of patients with LBP reporting pain in the legs; 31 however, the subgroup with true radicular pain is much smaller. A prospective cohort study of radicular pain in the Dutch general practice 10‐year follow‐up 20 found that the mean incidence was 9.4 episodes per 1000 person‐years. Radicular, neurogenic leg pain, for which there is no gold standard diagnosis, 18 is distinct from and more debilitating than somatic referred leg pain, and is associated with greater GP consultations, 18 functional limitations, work disability, anxiety, depression and reduced quality of life, 32 as well as imaging and surgical health care costs.…”

“…Recent research shows a favourable prognosis for all three radicular syndrome subsets when managed conservatively 18 , 20 , 36 . Referral to a spinal surgeon should be reserved for patients for whom conservative care has proven insufficient and who have disabling symptoms that have persisted for longer than 6 weeks, 37 , 38 for patients who have severe or progressive neurological deficit, and for patients with cauda equina syndrome 39 .…”

Tratamiento cognitivo conductual en pacientes con dolor lumbar en salud pública: Estudio piloto [Cognitive behavioral therapy in patients with low back pain in public health: A pilot study]

“…El 22% de las ocasiones el paracetamol es la primera elección en el tratamiento de las lumbalgias en atención primaria (Towheed et al, 2006), sin embargo, también son ampliamente utilizados los antiinfl amatorios no esteoides (AINEs) (Spijker-Huiges et al, 2015) y los relajantes musculares. Dentro de las intervenciones médicas empleadas para tratar el DL, un 11.6% de pacientes son intervenidos quirúrgicamente (Deyo y TsuiWu, 1987).…”

Power Point Therapy: An Effective and Simple Treatment for Subacute Back Pain – A Randomized Controlled Trial

“…In a recent cohort study of 605 acute back pain patients, 32% reported themselves fully recovered after 6 months, and 9% reported a worsening of the problems or felt the same [6]. About 10% of the patients with back pain proceed with surgical operation to treat the pain [7]. The annual direct costs for patients with chronic back pain are around EUR 3,100 per patient, and the indirect costs are around EUR 17,600, which makes chronic back pain one of the main burdens for the health care system [8, 9], and consequently preventing chronification a prime target.…”