Trajectories of acute low back pain

Abstract

Characterising the clinical course of back pain by mean pain scores over time may not adequately reflect the complexity of the clinical course of acute low back pain. We analysed pain scores over 12 weeks for 1585 patients with acute low back pain presenting to primary care to identify distinct pain trajectory groups and baseline patient characteristics associated with membership of each cluster. This was a secondary analysis of the PACE trial that evaluated paracetamol for acute low back pain. Latent class growth analysis determined a 5 cluster model, which comprised 567 (35.8%) patients who recovered by week 2 (cluster 1, rapid pain recovery); 543 (34.3%) patients who recovered by week 12 (cluster 2, pain recovery by week 12); 222 (14.0%) patients whose pain reduced but did not recover (cluster 3, incomplete pain recovery); 167 (10.5%) patients whose pain initially decreased but then increased by week 12 (cluster 4, fluctuating pain); and 86 (5.4%) patients who experienced high-level pain for the whole 12 weeks (cluster 5, persistent high pain). Patients with longer pain duration were more likely to experience delayed recovery or nonrecovery. Belief in greater risk of persistence was associated with nonrecovery, but not delayed recovery. Higher pain intensity, longer duration, and workers' compensation were associated with persistent high pain, whereas older age and increased number of episodes were associated with fluctuating pain. Identification of discrete pain trajectory groups offers the potential to better manage acute low back pain.

New insight to the characteristics and clinical course of clusters of patients with imaging confirmed disc‐related sciatica

“…The clinical course for leg pain and disability was favourable for all four clusters, with most improvement seen in the first 3 months. This early improvement is confirmed in other sciatica trajectory studies and is also seen in cohorts with non-specific low back pain (Axen & Leboeuf-Yde, 2013;Downie et al, 2016). An interesting observation is the early improvement in pain and disability across the four clusters despite approximately two of three patients in all clusters having their pain for over 3 months.…”

What have we learned from ten years of trajectory research in low back pain?

“…To our knowledge, LBP trajectories in adults have so far been identified by data driven approaches in ten cohorts [ 8 , 10 – 18 ]. In these studies, participants with a main complaint of LBP were followed from three to twelve months with data collection at four to 52 time-points.…”

“…In addition, all studies identified patterns that were neither a rapid recovery nor persistent severe pain. Different patterns of improvement in the very early course were mainly observed in the studies that included many patients with recent onset pain [ 11 , 12 , 18 ]. In addition, most studies described fluctuating patterns characterised by LBP of alternating intensity and/or by LBP episodes with periods of no pain.…”

Day-to-day experience in resolution of pain after surgery

“…Growth curve modeling has been previously applied to describe patterns of recovery over weeks in patients with acute low back pain [5] and over days in hospitalized medical and surgical patients [10]. Patterns of pain resolution in the first 5-6 5-6 postoperative days have been described and correlated with persistent pain months later [1; 4; 14], yet the few studies which have modeled these patterns have been restricted to short time periods (two weeks) [3] or included a paucity (≤ 6) measures [11; 13; 15; 16].…”