The prognosis of acute and persistent low-back pain: a meta-analysis

Abstract

Research CMAJ Background: Although low-back pain is a highly prevalent condition, its clinical course remains uncertain. Our main objective was to systematically review the literature on the clinical course of pain and disability in patients with acute and persistent low-back pain. Our secondary objective was to investigate whether pain and disability have similar courses. Methods:We performed a meta-analysis of inception cohort studies. We identified eligible studies by searching MEDLINE, Embase and CINAHL. We included prospective studies that enrolled an episode-inception cohort of patients with acute or persistent low-back pain and that measured pain, disability or recovery. Two independent reviewers extracted data and assessed methodologic quality. We used mixed models to determine pooled estimates of pain and disability over time.Results: Data from 33 discrete cohorts (11 166 participants) were included in the review. The variance-weighted mean pain score (out of a maximum score of 100) was 52 (95% CI 48-57) at baseline, 23 (95% CI 21-25) at 6 weeks, 12 (95% CI 9-15) at 26 weeks and 6 (95% CI 3-10) at 52 weeks after the onset of pain for cohorts with acute pain. Among cohorts with persistent pain, the variance-weighted mean pain score (out of 100) was 51 (95% CI 44-59) at baseline, 33 (95% CI 29-38) at 6 weeks, 26 (95% CI 20-33) at 26 weeks and 23 (95% CI 16-30) at 52 weeks after the onset of pain. The course of disability outcomes was similar to the time course of pain outcomes in the acute pain cohorts, but the pain outcomes were slightly worse than disability outcomes in the persistent pain cohorts. Interpretation:Patients who presented with acute or persistent low-back pain improved markedly in the first six weeks. After that time improvement slowed. Low to moderate levels of pain and disability were still present at one year, especially in the cohorts with persistent pain. Abstract

Kinesio Taping Does Not Provide Additional Benefits in Patients With Chronic Low Back Pain Who Receive Exercise and Manual Therapy: A Randomized Controlled Trial

“…ow back pain is a significant public health problem 2,8,30 that affects approximately 39% of individuals worldwide at some point in their lifetime. 13,16 Because of this high pre valence, clinical practice guidelines have been developed in order to summarize the best evidence for the care of these patients.…”

Four sessions of spinal manipulation, simple exercises and education are not better than usual care for patients with acute low back pain

“…Given that the prognosis of patients with acute LBP is favourable in a large proportion of patients,1 the results of this trial are not surprising. Based on previous studies on the effects of usual care in patients with acute LBP, it is almost impossible to meet an effect larger than the minimal clinical important difference.…”

Occupational illness

“…However, the patient can be reassured that most episodes of low-back pain are self-limiting, with most experiencing marked reduction of pain and disability in the first 6 weeks and the majority completely recovered by 12 weeks (Costa et al, 2012).…”