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Back pain tends to improve quickly, not completely

NEW YORK (Reuters Health) – Lower back pain often fades fairly quickly, but some patients are probably best off considering the problem to be a life-long condition, an author of a new meta-analysis told Reuters Health.

“Typically, back pain is a long-term, recurrent condition, so a quick fix is not realistic for most people,” Dr. Christopher G. Maher of the George Institute for Global Health in Sydney, Australia said in an email.

Nearly everyone experiences low back pain at some point. In the U.S., people spend at least $50 billion a year on treating the problem, according to the National Institutes of Health.

In their study, Dr. Maher and his colleagues found that people seeking treatment for persistent back pain (i.e., lasting three months or more) were especially likely to still have symptoms a year later.

The findings, reported online May 14th in the Canadian Medical Association Journal, come from pooled data on nearly 11,200 patients.

On average, people with acute back pain scored a 52 out of 100 on a standard pain scale at the time they sought treatment. Six weeks later, that score was down to 23, and after a year, it had fallen to a 6.

People with persistent back pain fared less well. They started with an average pain score of 51, then improved to 33 after six weeks, and finally to 23 after a year.

Patients with either acute or persistent back pain also showed fairly quick improvements in “disability” — such as difficulty with bending or lifting.

After a year, both groups had mild levels of disability, on average.

According to Dr. Maher, the findings suggest that persistent back pain is a problem that requires long-term management.

“People should think of back pain as probably more like asthma or diabetes, where maintaining a health lifestyle and good self-management are important if we want to get the most from life,” Dr. Maher said.

This analysis does not show what specifically works for back pain. People in the studies were on a variety of therapies.

But in general, Dr. Maher said, “we do have some information on what works for back pain.”

Based on guidelines from the American College of Physicians and American Pain Society, there’s “good” evidence that acute back pain can improve with over-the-counter pain killers, heat and staying active to the extent possible.

For persistent back pain, painkillers and formal exercise therapy may help. There is also evidence supporting spinal manipulation therapy and cognitive behavioral therapy.

“I think that most people with an episode of uncomplicated low back pain don’t need to seek care at all,” said Dr. Rachelle Buchbinder from Monash University in Malvern, Australia, who wrote an editorial published with the study.

“They can just manage it themselves, take analgesics if they need to, and continue to do their usual activities, including work,” she said in an email.

There are exceptions, however, she said. Severe pain is one. Another would be the case of an elderly person who has no history of back pain problems, given that low back pain can sometimes be a sign of a serious condition.


Can Med Assoc J 2012.