Study shines light on who develops chronic low back pain

Back pain is the leading reason that people seek out the help of a chiropractor, and it is estimated that 80 to 90% of people in the United States will experience some kind of back pain in their lives. Most patients with low back pain (LBP) will find their symptoms improve after a few weeks or months, and chiropractors can assist this process by identifying pain issues in the early stages and helping patients stay active during their recovery. However, in approximately 10% of cases, acute low back pain develops into a chronic condition, one that lasts six months or more. Chronic low back pain is very difficult to treat, and it can have a substantial impact on a patient's quality of life.

Research is beginning to uncover the factors that can determine who develops chronic low back pain, and these findings can have great relevance in determining a treatment path. In a study published in The Spine Journal, researchers from the Netherlands merged the results of three randomized controlled trials of a total 628 workers on medical leave for LBP. The trials drew from a wide base of professions, comparing results among airline, healthcare, industrial, construction, and office workers.

The researchers considered physical factors, including age and gender of participants, pain intensity, disability level, the amount of heavy lifting required at their job, as well as psychological factors like overall job satisfaction and fear of movement triggered by past pain experiences, also known as kinesiophobia. The study followed up with patients after one year to determine which patients had developed chronic conditions.

After reviewing their results, the researchers developed a short list of the most significant factors in predicting who will develop chronic low back pain. Patients who did not experience a decrease in pain intensity or their level of disability within the first three months of the onset of pain were most likely to develop a chronic condition. Those who started out with a higher pain intensity and those with a higher kinesiophobia where also determined to be at higher risk. Previous studies have suggested that patients who do more heavy lifting at work are at higher risk of developing a chronic condition, but this study could not confirm that this was as great a predictor as the other factors.

These findings have important implications for the treatment of low back pain. The results suggest that health practitioners, including chiropractors, should monitor the pain intensity and disability levels of patients with acute LBP frequently within the first three months of treatment. Patients whose symptoms don't change during this critical initial period may require more targeted treatment. In addition, initially intense pain levels can lead to a fear of movement that significantly impedes recovery, so care providers must also be proactive about reducing kinesiophobia in their low back pain patients.

Hemans MW, vanBuuren S, Knol DL, Anema JR, van Mechelen W, de Vet HCW. The prognosis of chronic low back pain is determined by changes in pain and disability in the initial period. The Spine Journal 2010 (10) 847-856.