Patients With Acute Low Back Pain Have Poor Prognosis

Few patients declare sick leave; many experience recurrences, chronic pain after initial episode

TUESDAY, April 24 (HealthDay News) -- Few patients with acute low back pain (LBP), with or without sciatica, declare sick leave; however, approximately half have one or more recurrences and a considerable proportion experience chronic pain six months or longer after the initial episode, according to a study published in the April 15 issue of Spine.

Wolf E. Mehling, M.D., of the University of California in San Francisco, and colleagues conducted a prospective cohort study involving 605 patients with up to 30 days of acute LBP, with or without sciatica, to evaluate the prognosis of these patients who are treated in the primary care setting. A total of 521 patients were available for follow-up at six months and 443 patients were available for follow-up at two years.

On a scale of one to 10, the researchers found the average pain intensity of study participants to be 5.6. The average disability score, measured on the Roland-Morris scale from 0 to 24, was 15.8. Between pain onset and baseline interview, only 8 percent declared sick leave. Chronic pain was experienced by 13 and 19 percent at six months and two years, respectively. Approximately half of patients experienced one or more recurrences of LBP (54 percent at six months and 47 percent in the subsequent 18 months).

"The prognosis of strictly defined acute LBP, with or without sciatica, is less favorable than commonly stated in practice guidelines based on failure to return to work " the authors write. "Broad initiatives to develop new means for the primary and secondary prevention of recurrent and chronic LBP are urgently needed."

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