image: Back pain can persist even when the initial injury has healed.
Credit: "Back Pain" by PracticalCures is licensed under CC BY 2.0.
Low back pain is a major cause of disability around the globe, with more than 570 million people affected. In the United States alone, health care spending on low back pain was $134.5 billion between 1996 and 2016, and costs are increasing.
"The good news is that most episodes of back pain recover, and this is the case even if you have already had back pain for a couple of months," University of South Australia Professor Lorimer Moseley says.
"The bad news is that once you have had back pain for more than a few months, the chance of recovery is much lower. This reminds us that although nearly everyone experiences back pain, some people do better than others, but we don't completely understand why."
The systematic review and meta-analysis, conducted by an international team of researchers, included 95 studies with the goal of understanding the clinical course of acute (< 6 weeks), subacute (6 to less than 12 weeks) and persistent (12 to less than 52 weeks) low back pain.
For people with new back pain, pain and mobility problems lessened significantly in the first 6 weeks, but then recovery slowed.
This study filled a gap in a 2012 paper from the same research team, with new findings showing that many people with persistent low back pain (more than 12 weeks) continue to have moderate-to-high levels of pain and disability.
"These findings make it clear that back pain can persist even when the initial injury has healed," Prof Moseley says.
"In these situations, back pain is associated with pain system hypersensitivity, not ongoing back injury. This means that if you have chronic back pain — back pain on most days for more than a few months — then it's time to take a new approach to getting better."
He notes that there are new treatments based on training both the brain and body that "focus on first understanding that chronic back pain is not a simple problem, which is why it does not have a simple solution, and then on slowly reducing pain system sensitivity while increasing your function and participation in meaningful activities."
The authors state that identifying slowed recovery in people with subacute low back pain is important so that care can be escalated and the likelihood of persistent pain reduced.
Further research into treatments is needed to help address this common and debilitating condition, and to better understand it in people younger than 18 and older than 60 years.
………………………………………………………………………………………………………………………….
Contact for interviews: Annabel Mansfield, Media and Communications, University of South Australia, Annabel.Mansfield@unisa.edu.au
Journal
Canadian Medical Association Journal
Method of Research
Systematic review
Subject of Research
Not applicable
Article Title
The clinical course of acute, subacute and persistent low back pain: a systematic review and meta-analysis
Article Publication Date
22-Jan-2024
COI Statement
Sarah Wallwork has received speaker fees from the Neuro Orthopaedic Institute and Exercise and Sport Science Australia. Felicity Braithwaite has received speaker fees from the Neuro Orthopaedic Institute, San Diego Pain Summit, Medicine Education Science and Health (MESH) . Mary O’Keeffe reports consulting fees from the European Pain Federation EFIC, honoraria from the Physio Network and travel support from INTERACT-EUROPE, PANACEA and Happy. Mervyn Travers has received speaker fees from Aalborg University, Australian Physiotherapy Association, Australian Podiatry Association, Life Ready Physiotherapy, PhysioFormation, Smart Education, O2 Academy, Healthia, Queensland Health, The University of Western Australia, Hemophilia Association Australia, Icelandic Physiotherapy Association and Rural Health West. Belinda Lange is a nonexecutive director of the Australian Physiotherapy Council and the Australasian Institute of Digital Health. G. Lorimer Moseley has received support from the National Health and Medical Research Council of Australia, the Medical Research Future Fund, Reality Health, Connect Health UK, Institutes of Health California, American International Assurance Australia, Workers’ Compensation Boards and professional sporting organisations (International Olympic Committee, English Premier League, La Liga, Australian Football League Clubs, National Basketball League, Athletics Australia, Cricket Australia). Professional and scientific bodies have reimbursed him for travel costs related to presentations of research on pain. He has received speaker fees for lectures on pain and rehabilitation from the Royal Australian College of General Practitioners, Noigroup Australia and MasterSessions. He receives royalties from Noigroup Publications, Orthopedic Physical Therapy Products and Dancing Giraffe Press. He sits on boards with Painaustralia and National Pain Solutions Research Alliance, and is chief executive officer with Pain Revolution. No other competing interests were declared.