Low back pain definitions: effect on patient inclusion and clinical profiles

Abstract

Introduction: Numerous definitions of acute low back pain (aLBP) exist. The use of different definitions results in variability in reported prevalence or incidence, conflicting data regarding factors associated with the transition to chronic LBP (cLBP), and hampers comparability among studies.Objective: Here, we compare the impact of 3 aLBP definitions on the number of aLBP cases and participants' characteristics and explore the distribution of participants across definitions. Methods: A sample of 1264 participants from the Quebec Low Back Pain Study was included. Three definitions of aLBP were used:(1) not meeting the National Institutes of Health (NIH) cLBP definition ("nonchronic"), (2) pain beginning ,3 months ago ("acute"), and (3) pain beginning ,3 months with a preceding LBP-free period ("new episode"). Results: There were 847, 842, and 489 aLBP cases meeting the criteria for the 3 definitions, respectively. Participants included in the "nonchronic" had lower pain interference, greater physical function scores, and fewer participants reporting .5 years of pain than in the other definitions. Half the participants meeting the "acute" definition and one-third of participants meeting the "new episode" definition were also classified as cLBP based on the NIH definition. Conclusions: Our results highlight the importance of the definition used for aLBP. Different definitions influence the sample size and clinical profiles (group's characteristics). We recommended that cohort studies examining the transition from aLBP to cLBP ensure that the definitions selected are mutually exclusive (ie, participants included [aLBP] differ from the expected outcome [cLBP]).

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“…This result reflects the confusion and little clarity in defining non-specific TSP. An accurate definition of the nonspecific origin of thoracic spine pain (TSP) is currently absent in the literature, unlike LBP and NP for which a definition exists [31,32]. Future studies should address this issue.…”

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“…They wanted to see whether the three definitions would identify groups that were similar in size and clinical characteristics. (See Massé-Alarie et al, 2022. )…”

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“…In addition to this prevalence problem, its disabling nature is another important concern to be considered. Since LBP is commonly associated with persistent pain, psychological impairments and limited mobility, patients report a significant disability and a significant reduction in the ability to perform work-related tasks (which leads to absenteeism and decreased productivity) [ 3 ]. Consequently, LBP represents a worrying economic burden, not only due to direct healthcare costs but also because of indirect costs such as lost earnings and reduced productivity [ 4 ].…”