Don’t despair over chronic back pain

Mike Marshall discusses the prognosis for lower back pain in the sixth in a series for The Independent on Saturday

OVER the past few weeks, we have discussed lower back pain under a number of headings: classification, warning signs, investigation, medication and rehabilitation. Now it’s time to consider the prognosis of lower back pain, to try to answer the question, “will my back pain get better?”

Most new episodes of lower back pain (ie acute or recent-onset back pain) recover within a few weeks, even without the patient seeking medical attention. Simply by avoiding activities that increase one’s symptoms and by using overthe-counter painkillers, adequate symptom relief is often achieved.

In addition, most patients with chronic lower back pain improve considerably during the first four weeks after seeking routine medical treatment.

So it would seem then that managing lower back pain presents no particular problem.

Or does it? Unfortunately it’s not actually that simple. The truth is that recurrent episodes of lower back pain are common and patients with chronic lower back pain tend to have a more persistent course of symptoms.

Sixty-six to 75% of patients with chronic lower back pain continue to experience mild back pain one month after seeking treatment in the primary care setting (eg treatment from a general practitioner).

In addition, up to 33% of chronic lower back pain patients report ongoing moderate pain and 20-25% report ongoing severe pain one month after being treated in a primary-care setting.

And the long-term follow-up data is not much better. When chronic lower back pain is managed in the primary care setting, about 33% of patients report intermittent or persistent pain of at least moderate intensity at the one-year follow-up mark.

In addition, one in seven patients continue to suffer lower back pain of severe intensity and one in five patients report substantial activity limitations one year after treatment in the primary care setting.

The previous articles in this series have discussed the importance of a multi-modal approach to managing chronic lower back pain.

Understanding the pathology of lower back pain, remaining active, using the appropriate medication, avoiding activities that increase symptoms, weight management and doing the correct rehabilitation exercises are all essential parts of an effective back-management programme.

Attending to all of these facets will provide a better prognosis for lower back pain patients than that achieved in the primary-care setting.

Also, there are a number of factors that are thought to be predictors of poor outcome in lower back pain. There isn’t absolute consensus in the medical literature regarding these factors, however they can help to identify patients at risk. Some of these factors include older age, poor general health, physically demanding work, increased psychological or psychosocial stress, the presence of sciatica (ie nerve pain radiating to the leg) and a lower initial functional level.

Of course, the idea of identifying these predictive factors in lower back pain is not so that the doctor can throw in the towel with certain patients.

Rather the presence of these factors helps to identify those patients that might require greater assistance and more specific management.

So finally, the message is, don’t despair if you have chronic lower back pain. The chance of your pain improving is actually quite good. Just make sure you seek out a medical service that will understand your particular case and that will manage you appropriately. If you do this, you can realistically expect to improve your functional abilities, reduce your pain and improve your long-term prognosis.