Course Of Back Pain Research Articles

The profile of older adults seeking chiropractic care: a secondary analysis

BackgroundMusculoskeletal conditions are the primary reason older adults seek general medical care, resulting in older adults as the highest consumers of health care services. While there is high use of chiropractic care by older adults, there is no recent, specific data on why older adults seek chiropractic care and how chiropractors manage conditions. Therefore, the purpose of this study was to describe the demographic characteristics of older adults seeking chiropractic care, and to report problems diagnosed by chiropractors and the treatment provided to older adults who seek chiropractic care.MethodsA secondary data analysis from two, large cross-sectional observational studies conducted in Australia (COAST) and Canada (O-COAST). Patient encounter and diagnoses were classified using the International Classification of Primary Care, 2nd edition (ICPC-2), using the Australian ICPC-2 PLUS general practice terminology and the ICPC-2 PLUS Chiro terminology. Descriptive statistics were used to summarize chiropractor, patient and encounter characteristics. Encounter and patient characteristics were compared between younger (< 65 years old) and older (≥65 years old) adults using χ2 tests or t-tests, accounting for the clustering of patients and encounters within chiropractors.ResultsA total of 6781 chiropractor–adult patient encounters were recorded. Of these, 1067 encounters were for persons aged > 65 years (16%), from 897 unique older patients. The most common diagnosis within older adult encounters was a back problem (56%), followed by neck problems (10%). Soft tissue techniques were most frequently used for older patients (85 in every 100 encounters) and in 29 of every 100 encounters, chiropractors recommended exercise to older patients as a part of their treatment.ConclusionsFrom 6781 chiropractor–adult patient encounters across two countries, one in seven adult chiropractic patients were > 65 years. Of these, nearly 60% presented with a back problem, with neck pain and lower limb problems the next most common presentation to chiropractors. Musculoskeletal conditions have a significant burden in terms of disability in older adults and are the most commonly treated conditions in chiropractic practice. Future research should explore the clinical course of back pain in older patients seeking chiropractic care and compare the provision of care to older adults across healthcare professions.

CLINICAL СASE: 41-YEAR MAN WITH NEUROLOGICAL SIGNS AND BACK PAIN AFTER PHYSICAL EXERCISES AND UNUSUAL IMAGING APPEARANCES

The aim was to describe the uncommon cause of back pain with successful treatment, precise diagnostic and good outcome. Lower back pain is prevalent among all the age groups and can derive from many potential anatomic sources. Here is presented the case of atypical course of back pain and neurological signs with point on importance of astute visualizations technics. This clinical case of 41-year old male patient who got back pain and neurological signs after intensive physical exercises and had no adequate response for anti-inflammatory and analgesic drugs demonstrated the importance of appropriate visualization and considering non-standard causes of these symptoms. This allowed to prescribe effective treatment with good outcome during follow-up period. This could be the supporting evidence for including such additional visualization in protocols for non-typical back pain after strenuous physical activity. Back pain is common condition with a variety of causes. It is important to consider them in case of inadequate results of treatment and use non-conventional investigation if appropriate, which improves the outcome. This could be the supporting evidence for including such additional visualization in protocols for non-typical back pain after strenuous physical activity.

Chronic lower back pain: diagnosis and current principles of therapy

Chronic nonspecific lower back pain (LBP) is one of the most common causes of adult disability. The chronic course of back pain is often supported by the patient's unhealthy lifestyle and the use of ineffective treatments. The combination of cognitive behavioral therapy, therapeutic exercises, gradually increased physical activity, and rational pharmacotherapy are effective in most cases of chronic non-specific LBP. In this disease, nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-choice drugs that should be prescribed in a short cycle. The choice of NSAIDs is determined by the presence of concurrent diseases in the patient and by the risk of developing adverse events. The paper discusses the efficacy and safety of meloxicam in non-specific NSAIDs.

Course of Back Pain in the Canadian Population: Trajectories, Predictors, and Outcomes.

To identify and describe back pain trajectory groups and to compare indicators of health status, medication, and health care use in these groups. A representative sample (n = 12,782) of the Canadian population was followed-up from 1994/1995 to 2010/2011. Participants were interviewed biannually and provided data on sociodemographic (e.g., education) and behavior-related (e.g., physical activity) factors, depression, comorbidities, pain, disability, medication use (e.g., opioids), and health care use (e.g., primary care visits). We used group-based trajectory analysis to categorize participants according to patterns in the course of their back pain during the 16-year follow-up period and compared indicators of pain, disability, medication, and health care use in the trajectory groups. A total of 45.6% of the participants reported back pain at least once during follow-up. Of those, we identified 4 trajectories: persistent (18.0%), developing (28.1%), recovery (20.5%), and occasional (33.4%). The persistent and developing groups were characterized as having pain that prevented activities, disability, depression, and comorbidities. There were significant differences in the patterns of medication and health care use across the groups, with a general trend of most to least health care and medication use in the persistent, developing, recovering, and occasional groups. Those in the recovery group had an increasing trajectory reflecting opioid and antidepressant use. Approximately 1 in 5 people with back pain experience a persistent pain trajectory with an associated increase in pain, disability, and health care use. Further research is needed to determine whether the groups identified represent different diagnoses, which may provide insight into the selection of stratified treatment and aid in designing early prevention and management strategies in the population.

Natural History of Back Pain in Older Adults over Five Years.

Back pain is a prevalent health problem. Research often focuses on adults. Evidence on the long-term course of back pain in older patients is limited. A prospective cohort study (BACE) was conducted in a primary care setting in the Netherlands. We aim to investigate the 5-year course and medical consumption of older adults (>55 years) presenting with back pain in general practice. Patients aged >55 years, consulting their general practitioner with a new back pain episode, were included between 2009 to 2011. Follow-up questionnaires included, for example, pain severity, disability, quality of life, recovery, and medical consumption. A total of 675 patients (mean age ± SD, 66.4 ± 7.6 years) participated, showing a mean (± SD) back pain reduction from 5.2 (± 2.7) to 3.6 (± 2.8) (numeric rating scale, 0 to 10) at 3 months follow-up; disability decreased from 9.8 (± 5.8) to 7.8 (± 6.2) (Roland-Morris Disability Questionnaire, 0 to 24). After 6 months, this remained practically constant over time. Medical consumption was highest in the first months; medication was used by 72% at baseline and approximately one-third (25% to 39%) during follow-up. At 5-year follow-up (response rate 58%; n = 392), 43% had recovered; a majority reported persistent or recurrent back pain. Clinically relevant improvements in back pain intensity and disability were seen in the first 3 to 6 months of follow-up. A majority of patients does not become pain free within 3 months; this does not improve over 5 years. However, most patients stop consulting health care professionals during follow-up. Current medical strategies may not be sufficient in older back pain patients, where back pain becomes a recurrent or chronic condition in the majority of patients.

Course and Contributors to Back Pain in Middle-aged Women Over 9 Years: Data From the Australian Longitudinal Study on Women's Health.

Community-based, cohort study. Our aim was to determine the course of back pain in middle-aged women over a 9-year period, and assess whether obesity and physical inactivity are associated with more frequent back pain. Back pain is the leading cause of disability worldwide. With minimal effective therapies and rising financial burden, identifying modifiable risk factors remains a key priority. The Australian Longitudinal Study on Women's Health is a cohort study of community-based, middle-aged women who completed questionnaires every 3 years between 2004 and 2013. Approximately, 10,530 women completed the survey in 2004 (mean age 55.5 yrs), and 9020 completed follow-up 9 years later. Self-reported data on back pain in the last 12 months and other sociodemographic factors were collected at all four surveys. 'Frequent back pain' was defined as back pain reported at ≥ three surveys. Back pain was common and persistent, with 48% having back pain in ≥ three out of four surveys. Baseline obesity (relative risk [RR] 1.18, 95% confidence interval [CI] 1.12-1.25), lack of vigorous physical activity (RR 1.17, 95% CI 1.10-1.25), depressive symptoms (RR 1.40, 95% CI 1.33-1.47), and low-education status (RR 1.17, 95% CI 1.12-1.24), were independently associated with an increased risk of frequent back pain (all P < 0.001). Overall, 28% of the risk of frequent back pain could be attributed to these factors, equating to one extra case of frequent back pain for every five women with depressive symptoms, for every 11 obese women, for every 12 women with low-education status, and for every 13 women who do not do vigorous physical activity, at baseline. Obesity, depressive symptoms, low-education status, and lack of vigorous physical activity are associated with higher risk of frequent back pain over the following 9 years among women in their mid-50 s. Targeting these risk factors may lessen the burden of back pain. 2.

Interpersonal problem behavior and low back pain.

ObjectiveThe theory of interpersonal problem behaviour (IPB) provides a more fundamental framework for understanding the psychosocial aspects of pain. The present study focused on the IPB, based on the Interpersonal Problem Circumplex (IPC), in persons with low back pain and its association with pain, psychological characteristics, and health care utilisation.MethodsIn a cross-sectional design, individuals with back pain (N = 88) and healthy control persons who matched by age, gender, and educational level (N = 88) were compared with regard to IPB. Furthermore, back pain patients classified by their IPB (N = 24 low, N = 48 moderate, N = 16 high) were compared regarding pain, depression, catastrophising, and health care utilisation.ResultsIn comparison to the healthy reference sample, a significant difference in the interpersonal problems of the low back pain group, with a tendency towards being overly ‘introverted’, ‘exploitable’, and ‘subassertive’, was revealed. In the back pain group, participants with elevated IPB showed significantly higher levels of pain intensity, functional disability, depression, catastrophising, and health care utilisation than participants with IPB in the normal range.ConclusionApplication of the Interpersonal Circumplex Model can help to characterize a subgroup of persons with low back pain. Increased general interpersonal problems are associated with elevated burden in pain-related, psychological, and health care-related variables. Future research should focus on the treatment opportunities for this subgroup, as well as on the influence of interpersonal problems during the course of back pain.

Long-term outcomes of a large, prospective observational cohort of older adults with back pain

Background ContextAlthough back pain is common among older adults, there is relatively little research on the course of back pain in this age group. PurposeOur primary goals were to report 2-year outcomes of older adults initiating primary care for back pain and to examine the relative importance of patient factors versus medical interventions in predicting 2-year disability and pain. Study Design/SettingThis study used a predictive model using data from a prospective, observational cohort from a primary care setting. Patient SampleThe study included patients aged ≥65 years at the time of new primary care visits for back pain. Outcome MeasuresSelf-reported 2-year disability (Roland-Morris Disability Questionnaire [RDQ]) and back pain (0–10 numerical rating scale [NRS]). MethodsWe developed our models using a machine learning least absolute shrinkage and selection operator approach. We evaluated the predictive value of baseline characteristics and the incremental value of interventions that occurred between 0 and 90 days, and the change in patient disability and pain from 0 to 90 days. Limitations included confounding by indication and unmeasured confounding. ResultsOf 4,665 patients (89%) with follow-up, both RDQ (from mean 9.6 [95% confidence interval {CI} 9.4–9.7] to mean 8.3 [95% CI 8.0–8.5]) and back pain NRS (from mean 5.0 [95% CI 4.9–5.1] to mean 3.5 [95% CI 3.4–3.6]) scores improved slightly. Only 16% (15%-18%) reported no back pain-related disability or back pain at 2 years after initial visits. Regression model parameters explained 40% of the variation (R2) in 2-year RDQ scores, and the addition of 0- to 3-month change in RDQ score and pain improved prediction (R2=51%). The most consistent predictors of 2-year RDQ scores and back pain NRS scores were 0- to 90-day change in each respective outcome and patient confidence in improvement. Patients experienced 50% and 43% improvement in back pain and disability, respectively, 2 years after their initial visit. However, fewer than 20% of patients had complete resolution of their back pain and disability at that time. ConclusionsBaseline patient factors were more important than early interventions in explaining disability and pain after 2 years.

Characterizing the course of back pain after osteoporotic vertebral fracture: a hierarchical cluster analysis of a prospective cohort study.

Understanding the natural course of symptomatic acute OVF is important in deciding the optimal treatment strategy. We used latent class analysis to classify the course of back pain after OVF and identify the risk factors associated with persistent pain. This multicenter cohort study included 218 consecutive patients with ≤2-week-old OVFs who were enrolled at 11 institutions. Dynamic x-rays and back pain assessment with a visual analog scale (VAS) were obtained at enrollment and at 1-, 3-, and 6-month follow-ups. The VAS scores were used to characterize patient groups, using hierarchical cluster analysis. VAS for 128 patients was used for hierarchical cluster analysis. Analysis yielded four clusters representing different patterns of back pain progression. Cluster 1 patients (50.8%) had stable, mild pain. Cluster 2 patients (21.1%) started with moderate pain and progressed quickly to very low pain. Patients in cluster 3 (10.9%) had moderate pain that initially improved but worsened after 3months. Cluster 4 patients (17.2%) had persistent severe pain. Patients in cluster 4 showed significant high baseline pain intensity, higher degree of angular instability, and higher number of previous OVFs, and tended to lack regular exercise. In contrast, patients in cluster 2 had significantly lower baseline VAS and less angular instability. We identified four distinct groups of OVF patients with different patterns of back pain progression. Understanding the course of back pain after OVF may help in its management and contribute to future treatment trials.

BACK PAIN RISK FACTORS IN ADOLESCENT ATHLETES: SUITABILITY OF A BIOMECHANICAL SCREENING TOOL?

BackgroundBack pain (BP) is already a relevant injury site in adolescent athletes. A valid screening is essential for BP prevention.ObjectiveTo investigate whether a biomechanical screening tool (BST) is suitable to...

Defining trajectories in older adults with back pain presenting in general practice.

although back pain is a frequently recurring disorder, the course of back pain remains uncertain. Therefore, this study aimed to identify different trajectories in older adults with back pain who presented in general practice and to determine which baseline characteristics are associated with these trajectories. the BACE study is a prospective cohort study including 675 patients (aged>55 years) with back pain who consulted a general practitioner; patients were followed for 3 years. Latent class growth analysis was used to identify different trajectories in back pain severity measured at eight different time points. A multinomial regression analysis was used to assess variables associated with membership of an identified trajectory. using the different indices of fit and the usefulness of the different trajectories in clinical practice, a 3-class cubic model was determined to be the best model. The three trajectories were defined as 'low pain trajectory', 'high pain trajectory' and 'intermediate pain trajectory'. Baseline variables associated with a higher chance of being in the intermediate or high trajectory were: female gender, higher body mass index, chronic back pain, more disability, lower scores on the SF-36 physical summary scale, and negative expectations of recovery. three different back pain trajectories were identified in older adults presenting with back pain in general practice. Various baseline characteristics were associated with a higher chance of being in the high or intermediate back pain trajectory. These characteristics might help identify patients at risk for a less favourable outcome.

Trajectories of acute low back pain: a latent class growth analysis.

Characterising the clinical course of back pain by mean pain scores over time may not adequately reflect the complexity of the clinical course of acute low back pain. We analysed pain scores over 12 weeks for 1585 patients with acute low back pain presenting to primary care to identify distinct pain trajectory groups and baseline patient characteristics associated with membership of each cluster. This was a secondary analysis of the PACE trial that evaluated paracetamol for acute low back pain. Latent class growth analysis determined a 5 cluster model, which comprised 567 (35.8%) patients who recovered by week 2 (cluster 1, rapid pain recovery); 543 (34.3%) patients who recovered by week 12 (cluster 2, pain recovery by week 12); 222 (14.0%) patients whose pain reduced but did not recover (cluster 3, incomplete pain recovery); 167 (10.5%) patients whose pain initially decreased but then increased by week 12 (cluster 4, fluctuating pain); and 86 (5.4%) patients who experienced high-level pain for the whole 12 weeks (cluster 5, persistent high pain). Patients with longer pain duration were more likely to experience delayed recovery or nonrecovery. Belief in greater risk of persistence was associated with nonrecovery, but not delayed recovery. Higher pain intensity, longer duration, and workers' compensation were associated with persistent high pain, whereas older age and increased number of episodes were associated with fluctuating pain. Identification of discrete pain trajectory groups offers the potential to better manage acute low back pain.

Pregnancy after Lumbar Total Disc Replacement

Introduction There is much literature addressing back pain and pregnancy, often attributing the pain to changing loads and stresses on the spine. There is much less information available on pregnancy after lumbar spinal surgery. Many women considering surgery or who have undergone surgery are of child-bearing age. They may have concerns about the safety of pregnancy after surgery. This may be particularly true of procedures performed through an anterior approach, such as lumbar total disc replacement (TDR). The purpose of this study was to evaluate the course of back pain and safety of pregnancy after lumbar TDR. Patients and Methods From a single center, 18 patients were identified who became pregnant after lumbar TDR surgery. Data were recorded from clinic records and mailed questionnaires. Questionnaire data were collected for 15 of 18 patients, although not all patients responded to all questions. For the remaining three patients, as much data as possible were collected from charts. The mean patient age at the time of surgery was 28.2 years, ranging from 25 to 35 years. The majority of patients (77.8%) had a single level operation with L5–S1 being the most common. Results Information related to back pain during pregnancy was available for 16 patients. Eight (50%) reported no increase in back pain during pregnancy, while the remaining eight did report increased back pain. Among the eight patients with increased back pain, it resolved postdelivery in all but one. There were no pregnancy-related complications. The mean time from surgery to delivery was 38.7 months (range, 9–102 months). Of the 15 patients for whom delivery method information was available, 10 (66.7%) had caesarian delivery while 5 (33.3%) had vaginal delivery. Of the 15 patients, 13 carried to term. The remaining two patients delivered twins prematurely. The mean birth weight was 7.4 pounds with the exception of the two sets of twins who had a mean weight of 4.4 pounds (range, 3.9–4.9 pounds). Three patients experienced two pregnancies post-TDR. Data for the first pregnancy are included earlier. In all the three patients, the second pregnancy was carried to term; one had a cesarean delivery, and the other two had vaginal delivery. One of the three had increased back pain during pregnancy which resolved after delivery. Conclusion Although based on a small patient sample, this study found that pregnancy after lumbar TDR surgery followed a typical course with no spine-related complications. The percentage of women delivering via cesarean delivery was greater than the 32.8% reported in the Center for Disease Control and Prevention's National Center for Health Statistics for 2012. It is hoped that this study may provide reassurance to women who were pregnant after TDR surgery that they should not be unduly concern about the safety of pregnancy and delivery because of their spine surgery.

Beliefs of Australian Physical Therapists Related to Lumbopelvic Pain Following a Biopsychosocial Workshop

INTRODUCTIONHealth care practitioner (HCP) beliefs are a catalyst of clinical behaviors and outcomes,1 with evidence emerging in the literature. The purpose of this study was to determine if participation in a 1-day workshop focusing on the biopsychosocial nature of pelvic girdle pain (under the broad contemporary understanding of lumbopelvic pain disorders) would influence the beliefs of physical therapists in Australia. Insufficient data investigating the effect of education on lumbopelvic pain beliefs of qualified physical therapists in Australia are available in the literature.REVIEW OF THE LITERATUREThere is growing recognition of the need to consider pain disorders from a biopsychosocial perspective.2'5 Within this model there is growing interest in the role of beliefs of both the patient and the HCP.6For patients, the future course and inevitability of back pain has been identified as an important aspect of back pain beliefs. Research has identified that greater levels of disability in adults with non-specific chronic low back pain (LBP) are associated with negative back pain beliefs.710 These beliefs center on the notions that back pain requires rest and extended absences from work, that painful activity should be avoided, that back trouble is indicative of a weak back, and that back pain will relegate the afflicted to a wheelchair. These negative thoughts do not align to current understanding regarding the course of back pain, and are inconsistent with the presently broad guidelines for back pain management. In adults, negative back pain beliefs have been associated with increased absenteeism from work, reduced work productivity,11'13 and poorer long-term outcomes.13,14 Furthermore, recent research has shown that negative back pain beliefs are related to activity avoidance in subjects with adolescent LBP.15 Taken together, these findings suggest that beliefs in the future course and inevitability of back pain can be a significant factor in LBP-related disability levels.Back pain beliefs are influenced by culture,8 familial environment,16 professional training,8 pain experience,6 depression,17 education level, perceived general health, work absenteeism, and LBP activity limitation.18 Backpain beliefs can be positively influenced with education.19'21 Improvements in back pain beliefs are associated with reduced absenteeism and fewer claims for LBP.21,22 However, to date, this has not been investigated in relation to pelvic girdle pain. Pelvic girdle pain describes musculoskeletal disorders of the anatomical pelvis, which includes the sacroiliac joints, symphysis pubis and associated ligamentous structures.23 Pelvic girdle pain disorders have been recognized as a distinctly separate set of disorders from LBP disorders. Pelvic girdle pain commonly occurs during pregnancy, but is not limited to that circumstance.23It's important to note that the beliefs of HCPs may influence the beliefs of patients,1,24 and influence patient management.1,25 Recommending time off work to cope with LBP, for example, can be the result of HCP avoidance beliefs,26 adherence of a biomedical model of pain, or lower behavioral understanding of I.BP.27'29 Similarly, HCP beliefs may influence advice given to patients regarding general activity.26,28 This highlights the importance of understanding the back pain beliefs of HCPs.While HCP beliefs related to LBP have been a growing focus of research, the same cannot be said for pelvic girdle pain. Though anatomical differences are acknowledged, there are clear similarities between persistent LBP and pelvic girdle pain disorders when viewed from a biopsychosocial perspective.3,4,23,30 Beliefs related to pelvic girdle pain, like those of LBP, may act as a barrier to effective management of these disorders.4,30 liiere is evidence of a mismatch between HCP advice regarding pelvic girdle pain and the beliefs of the subjects.31 The beliefs of the patients regarding the future consequences of pelvic girdle pain are highly predictive of outcome. …

Long-term trajectories of back pain: cohort study with 7-year follow-up

ObjectiveTo describe long-term trajectories of back pain.DesignMonthly data collection for 6 months at 7-year follow-up of participants in a prospective cohort study.SettingPrimary care practices in Staffordshire, UK.Participants228 people consulting their...

Course and prognosis of older back pain patients in general practice: A prospective cohort study

The aim of the current study was to determine the course of back pain in older patients and identify prognostic factors for non-recovery at 3months’ follow-up. We conducted a prospective cohort study (the BACE study) of patients aged >55years visiting a general practitioner (GP) with a new episode of back pain in the Netherlands. The course of back pain was described in terms of self-perceived recovery, pain severity, disability, pain medication, and GP visits at 6weeks’ and 3months’ follow-up. Prognostic factors for non-recovery at 3months’ follow-up were derived from the baseline questionnaire and physical examination. Variables with a prognostic value were identified with multivariable logistic regression analysis (method backward), and an area under the receiver operating curve (AUC) was calculated for the prognostic model. A total of 675 back pain patients (mean age 66.4 (SD 7.6) years) participated in the BACE cohort study. At 6weeks’ follow-up 64% of the patients reported non-recovery from back pain. At 3months’ follow-up 61% still reported non-recovery, but only 26% of these patients had revisited the GP. Longer duration of the back pain, severity of back pain, history of back pain, absence of radiating pain in the leg below the knee, number of comorbidities, patients’ expectation of non-recovery, and a longer duration of the timed ‘Up and Go’ test were significantly associated with non-recovery in a multiple regression model (AUC 0.79). This information can help GPs identify older back pain patients at risk for non-recovery.

Back Complaints in the Elders (BACE); design of cohort studies in primary care: an international consortium

BackgroundAlthough back complaints are common among older people, limited information is available in the literature about the clinical course of back pain in older people and the identification of older persons at risk for the transition from acute back complaints to chronic back pain.The aim of this study is to assess the course of back complaints and identify prognostic factors for the transition from acute back complaints to chronic back complaints in older people who visit a primary health care physician.Methods/designThe design is a prospective cohort study with one-year follow-up. There will be no interference with usual care. Patients older than 55 years who consult a primary health care physician with a new episode of back complaints will be included in this study.Data will be collected using a questionnaire, physical examination and X-ray at baseline, and follow-up questionnaires after 6 weeks and 3, 6, 9 and 12 months.The study 'Back Complaints in the Elders' (BACE) will take place in different countries: starting in the Netherlands, Brazil and Australia. The research groups collaborate in the BACE consortium. The design and basic objectives of the study will be the same across the studies.DiscussionThis consortium is a collaboration between different research groups, aiming to provide insight into the course of back complaints in older people and to identify prognostic factors for the transition from acute back complaints to chronic back complaints in older persons. The BACE consortium allows to investigate differences between older people with back complaints and the health care systems in the different countries and to increase the statistical power by enabling meta-analyses using the individual patient data. Additional research groups worldwide are invited to join the BACE consortium.

Are Modic changes prognostic for recovery in a cohort of patients with non-specific low back pain?

There is evidence for an association between Modic type 1 and pain in patients with low back pain (LBP), but little knowledge about its effect on clinical outcomes. (1) To assess the prevalence of Modic changes, (2) to determine if Modic changes influence the clinical course of LBP, and (3) to identify prognostic factors for recovery. Prospective clinical cohort study, with a 1-year follow-up. The treatment consisted of brief intervention and instruction in stretching. PATIENT'S SAMPLE: Two hundred and sixty-nine patients with chronic low back pain. Socio-demographic variables, education, profession, self-reported measures, degenerative changes on MRI. Linear growth model and Cox regression analysis. Five percent had a normal MRI, 14 and 50% had Modic 1 and Modic 2 changes. Modic changes were not significant covariates for the clinical course of pain, function or fear avoidance beliefs. Education was a strong prognostic factor for recovery. Modic changes did not influence the clinical course of back pain and were not prognostic factors for recovery. Education was strongly associated with recovery.

The course of back pain among older community dwelling men: The MrOS Study

Variability of back pain (BP) symptoms over time is not well understood, especially among older individuals. To identify BP patterns during two years of follow-up, we studied 5735 community dwelling men age 65-100 years. On 6 questionnaires mailed every 4 months after enrollment, men reported if they had any BP in the past 4 months and the number of days (0, 1-7, 8-14, >14) BP was severe. The frequency of BP was defined as the sum of BP reports. Categories of days with severe BP were assigned 0-3 points, respectively, and summed over the 6 questionnaires for a ‘severity score’ of 0-18 points. High frequency was considered 3-6 reports of BP. High severity BP was considered 10-18 points. The ‘never pain’ group (39%) reported no BP over the 2 year period. Among the 61% with BP, four patterns were identified: ‘intermittent pain’ (BP coming and going throughout follow-up) (36%); ‘always pain’ (14%); ‘resolved pain’ (BP followed by ≥2 consecutive reports of no BP) (6%); and ‘new persistent pain‘(no BP followed by ≥2 consecutive reports of BP) (5%). The majority with ‘intermittent pain’ (73%) had low frequency, of which none had high severity. Among the intermittent group with high frequency, 11% had high severity BP. In the ‘always pain’ group, half (51%) had low severity and half (49%) had high severity BP. In the ‘new persistent pain’ group, 10% had high severity, whereas in the ‘resolved pain’ group only 1% had high severity BP. We further explored the frequency of ‘chronic severe pain,’ defined as ≥2 consecutive reports of >14 days with severe BP. This subset of 526 men was comprised of ‘always’ (67%), ‘intermittent’ (20%), and ‘new persistent’ (13%) groups. Among community dwelling older men, five distinct patterns of BP were identified that varied in both frequency and severity.

Ten year course of low back pain in an adult population-based cohort – The Doetinchem Cohort Study

Background The long-term course of long-standing low back pain is largely unknown since long-term data are scarce. Objective We examined the course of self-reported low back pain in the prospective population-based Doetinchem cohort over a period of 10 years. Methods Between 1993 and 2007, around 5700 randomly selected men and women in four age groups of originally 20–29, 30–39, 40–49, 50–59 years were measured three times. Logistic regression analysis was used to study the association of sociodemographic (gender, age, education, work status) and lifestyle characteristics (BMI, smoking, physical activity) with persistent and new episodes of long-standing low back pain. Results The prevalence of long-standing low back pain is quite stable over a 10 year period, approximately 20% on population level. On individual level, around 30% of the population was completely free of low back pain during the entire period, 6% can be characterized as persistent back pain sufferers. Individuals with persistent and a varying pattern have a more unhealthy lifestyle (BMI and smoking) than those without low back pain. Age, smoking, obesity and not having a paid job are associated with 10-year persistent back pain in the general population, whereas age and not having a paid job are associated in those with long-lasting back pain at baseline. New episodes of long-standing back pain are relatively frequent among women and smokers. Conclusions Low back pain in the population is characterized as very dynamic which challenges epidemiological studies highly. Long-term information on the course of back pain is needed to define severe subgroups.