What can we learn from long-term studies on chronic low back pain? A scoping review

Abstract

Purpose A scoping review was conducted with the objective to identify and map the available evidence from long-term studies on chronic non-specific low back pain (LBP), to examine how these studies are conducted, and to address potential knowledge gaps. Method We searched MEDLINE and EMBASE up to march 2021, not restricted by date or language. Experimental and observational study types were included. Inclusion criteria were: participants between 18 and 65 years old with non-specific sub-acute or chronic LBP, minimum average follow-up of > 2 years, and studies had to report at least one of the following outcome measures: disability, quality of life, work participation, or health care utilization. Methodological quality was assessed using the Effective Public Health Practice Project quality assessment. Data were extracted, tabulated, and reported thematically. Results Ninety studies met the inclusion criteria. Studies examined invasive treatments (72%), conservative (21%), or a comparison of both (7%). No natural cohorts were included. Methodological quality was weak (16% of studies), moderate (63%), or strong (21%) and generally improved after 2010. Disability (92%) and pain (86%) outcomes were most commonly reported, followed by work (25%), quality of life (15%), and health care utilization (4%). Most studies reported significant improvement at long-term follow-up (median 51 months, range 26 months–18 years). Only 10 (11%) studies took more than one measurement > 2 year after baseline. Conclusion Patients with persistent non-specific LBP seem to experience improvement in pain, disability and quality of life years after seeking treatment. However, it remains unclear what factors might have influenced these improvements, and whether they are treatment-related. Studies varied greatly in design, patient population, and methods of data collection. There is still little insight into the long-term natural course of LBP. Additionally, few studies perform repeated measurements during long-term follow-up or report on patient-centered outcomes other than pain or disability.

Quality of Life in Patients with Chronic Low Back Pain and Differences by Sex: A Longitudinal Study

“…McKenzie therapy and Pilates [3] and mindfulness [32] are the most effective strategies to significantly improve pain, functional states, mental health, self-control and adaptive coping strategies, which is supported by strong evidence [33,34].…”

“…In this respect, daily functional limitation affects the usual occupational activity of workers. The associated disability, absence from work and invalidity create a greater risk of pain chronification, higher levels of pain and worse perceived health [33], which have high family and social costs [38], affecting men to a lesser extent [21]. The avoidance of certain occupational exposures, such as repetitive mechanical overloading, and the adoption of ergonomic habits at the workplace prevent the chronification of pain and the worsening of perceived pain and improve perceived health [8,37].…”

The effect of kinesiotherapy supported by visual biofeedback on a stabilometric platform on health-related quality of life among patients with non-specific low back pain. A randomized, open-label study with a 6-month follow-up

“…Numerous pharmacological (e.g., NSAIDs, opioids, paracetamol, anti-depressants, and muscle relaxants), non-pharmacological (e.g., exercise, patient education, www.journals.viamedica.pl/medical_research_journal manual therapies, psychological therapies, multidisciplinary physiotherapeutic approaches, massage, acupuncture, mindfulness, and whole-body vibration) and invasive and non-invasive methods of treatment are available. However, the diversity of the outcomes measured, inadequate descriptions of methodology and the poor reporting of interventions, as well as a low number of high-quality randomized controlled trials on chronic NSLBP treatment, make it difficult to compare the effectiveness and safety of NSLBP therapeutic methods [2][3][4][5][6][7][8][9][10]. The following endpoints for evaluating the effectiveness of NSLBP therapy are commonly measured: severity of disability, pain, work productivity, and healthcare utilization [3,11].…”

“…However, the diversity of the outcomes measured, inadequate descriptions of methodology and the poor reporting of interventions, as well as a low number of high-quality randomized controlled trials on chronic NSLBP treatment, make it difficult to compare the effectiveness and safety of NSLBP therapeutic methods [2][3][4][5][6][7][8][9][10]. The following endpoints for evaluating the effectiveness of NSLBP therapy are commonly measured: severity of disability, pain, work productivity, and healthcare utilization [3,11]. Changes in health-related quality of life (HRQoL) domain scores as indications of the effectiveness of treatment among NSLBP patients are rarely reported in the literature, despite HRQoL surveys, which estimate patients' suffering and physical and psychological functioning, being considered among the targets to be prioritized in NSLBP therapy [3,12].…”

Does the anesthesia technique of cesarean section cause persistent low back pain after delivery? A retrospective analysis

“…Today, LBP is one of the most common problems worldwide [1][2][3][4]. LBP is the most common health problem in the European workforce [5].…”