The course of chronic and recurrent low back pain in the general population

Abstract

Using latent class analysis (LCA), a previous study on patients attending primary care identified four courses of low back pain (LBP) over the subsequent 6 months. To date, no studies have used longitudinal pain recordings to examine the "natural" course of recurrent and chronic LBP in a population-based sample of individuals. This study examines the course of LBP in the general population and elaborates on the stability and criterion-related validity of the clusters derived. A random sample of 400 individuals reporting LBP in a population-based study was asked to complete a comprehensive questionnaire at the start and end of the year's survey, and 52 weekly pain diaries in between. The latter were analyzed using LCA. 305 individuals returned more than 50% of the diaries. Four clusters were identified (severe persistent, moderate persistent, mild persistent, and fluctuating). The clusters differed significantly with regards to pain and disability. Assessment of cluster stability showed that a considerable proportion of patients in the "fluctuating" group changed their classification over time. Three of the four clusters describing the typical course of pain matched the clusters described previously for patients in primary care. Due to the population-based design, this study achieves, for the first time, a close insight into the "natural" course of chronic and recurrent low back pain, including individuals that did not necessarily visit the general practitioner. The findings will help to understand better the nature of this pain in the general population.

Changes in lumbar multifidus muscle function and nociceptive sensitivity in low back pain patient responders versus non-responders after dry needling treatment

“…Since some of the participants in the non-responder group reported a slight worsening of their symptoms at the one-week follow-up, the decreased percent thickness change during muscle contraction could be related to pain inhibition (Kiesel et al, 2008). Alternatively, because the actual magnitude of these changes were quite small (2e3%) and within estimates of measurement error (Koppenhaver et al, 2009a), they could have been due to chance, inter-day variability, or the natural history of improvement and recurrent episodes of pain in people with LBP (Tamcan et al, 2010).…”

Patients with low back pain had distinct clinical course patterns that were typically neither complete recovery nor constant pain. A latent class analysis of longitudinal data

“…Subgroups based on LBP trajectories have previously been identified in studies of six different cohorts [6][7][8][9][10][11]. Five of these used some sort of computerized subgrouping technique [6][7][8][9]11] and described four to five distinct LBP trajectories.…”

“…Five of these used some sort of computerized subgrouping technique [6][7][8][9]11] and described four to five distinct LBP trajectories. Within these studies, substantial differences between the identified subgroups indicate that the traditional use of only a population-averaged clinical trajectory may be limiting, or even distorting, our understanding of LBP.…”

Occupational, Personal and Psychosocial Resources for Preventing Persistent Low Back Pain

“…Further research is required to confirm the role of different types of social support regarding their prognostic influence on the development of persistent LBP. Furthermore, future studies should assess recovery more frequently, e.g., weekly or even daily [47] and might use texts (short message service, SMS) to collect outcomes [48].…”