Why does acute back pain become chronic?

Abstract

Acute episodes of back pain are remarkably common. There is a high natural remission rate, with about 90% of cases resolving within six weeks.1 For patients with simple backache–acute onset of pain in the back without nerve root symptoms or signs of serious spinal pathology–bed rest is indicated only if the patient is in great pain and unable to stand or walk, and should be only for a short period. Analgesia and early physical activation improve the rate of recovery and allow early return to work.2 Despite these optimistic findings the prevalence of chronic or recurrent back problems is high–present in up to 39% of adults.3 Much effort is expended searching for a specific organic diagnosis such as a herniated lumbar spine, annular tears, spinal stenosis, or spondylolisthesis. But in the vast majority of cases it is impossible to identify the source of the pain. Patients may show limitation of spine movements, radiological spondylosis, facet joint osteoarthritis, or signs of disc degeneration and protrusion on magnetic resonance imaging. However, these commonly identified features have only weak correlations with the presence of back pain. Extensive epidemiological studies have demonstrated little or no correlation between back problems and inherited factors, height, weight, deformity (unless …