A professor breaks down the good and bad news for those suffering from low back pain, as well as when it’s time to explore other treatment options.

Low back pain stands as a significant contributor to global disability, impacting over 570 million individuals.

In the United States, the financial burden of addressing low back pain reached $134.5 billion between 1996 and 2016, and these costs continue to rise.

“The good news,” according to Professor Lorimer Moseley from the University of South Australia, “is that most episodes of back pain recover, and this is the case even if you have already had back pain for a couple of months.”

“The bad news is that once you have had back pain for more than a few months, the chance of recovery is much lower,” warns the professor.

“This reminds us that although nearly everyone experiences back pain, some people do better than others, but we don’t completely understand why.”

An international team of researchers did a systematic review and meta-analysis of 95 papers to better understand the clinical course of acute (<6 weeks), subacute (6 to <12 weeks), and chronic (12 to <52 weeks) low back pain.

For patients with new back pain, pain, and mobility difficulties improved dramatically during the first 6 weeks, but afterward recovery declined.

This study addressed a gap in a 2012 report by the same research team, revealing that many people with chronic low back pain (greater than 12 weeks) continue to have moderate-to-high levels of pain and impairment.

“These findings make it clear that back pain can persist even when the initial injury has healed,” remarks Prof Moseley.

“In these situations,” as explained by the professor, “back pain is associated with pain system hypersensitivity, not ongoing back injury.”

“This means that if you have chronic back pain — back pain on most days for more than a few months — then it’s time to take a new approach to getting better.”

He mentions that there are new treatments based on brain and body training that “focus on first understanding that chronic back pain is not a simple problem, which is why it does not have a simple solution, and then on slowly reducing pain system sensitivity while increasing your function and participation in meaningful activities.”

According to the authors, it’s critical to identify individuals with subacute low back pain who have impaired recovery to improve therapy and lower the risk of chronic pain.

Additional investigation into treatments is essential to tackle this prevalent and incapacitating condition.

It is crucial to gain a deeper understanding of this issue, especially in individuals under 18 and those above 60 years of age, they write.

Source: 10.1503/cmaj.230542

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