Researchers Define Sets of Patient Experiences for Low Back Pain
Commentary by Giulia Norton, PhD
Researchers have found that patients with low back pain typically follow distinct sets of patient experience. While half of patients recover immediately, the other half maintain a high likelihood of receiving care in every subsequent quarter, according to a report in The Spine Journal.
“The rationale for our study was that research on treatments for low back pain is difficult to compare, due to differences across studies in definitions, inclusion criteria, baseline assessments, and outcome measures,” said Giulia Norton, PhD, who completed the study while at Boston University, Boston, Mass. “As a result, clinicians have difficulty comparing the effectiveness of interventions as reported by different studies,” Dr. Norton said.
“We studied the treatment patterns of over 65,000 people for more than 2 years after their incident (first) case of low back pain, defined as an episode for which the person got treatment after 6 months with no evidence of low back pain,” Dr. Norton said.
“We found that half of the patients [53.4%] recovered immediately—they got no more treatment despite still being insured—but the other half experienced repeated relapses over more than 2 years. Half of the patients were very likely (37%-89%) to receive treatment for low back pain in each quarter after their first episode,” Dr. Norton said.
Single Episode of Low Back Pain is a Strong Predictor of Future Episodes
“For clinicians and patients, the primary message is that an episode of low back pain is a very strong predictor for future episodes,” Dr. Norton said. “It is an opportunity for an analysis of the etiology [of low back pain] and for guidance to preventing subsequent cases, including active patient involvement,” she said.
Dr. Norton hopes that researchers will take away 3 messages from the study: “First, researchers must describe specific inclusion and exclusion criteria in order for research to be comparable. For example, each article should clearly state whether subjects had a new or recurrent case of low back pain.”
“Second, a period of at least 6, and preferably 12, months with no evidence of low back pain should be required to specify a new case,” Dr. Norton said. “Third, pain, functional limitation, and bothersomeness are likely to vary over time for many patients with low back pain. Therefore, rather than measuring outcomes at a small number of time points, more frequent measurement describing cumulative experience will more accurately estimate outcomes for low back pain,” she concluded.