Absence of Low Back Pain to Demarcate an Episode: A Prospective Multicentre Study in Primary Care
SOURCE: Chiropractic & Manual Therapies 2016 (Feb 18); 24: 3
Andreas Eklund, Irene Jensen, Malin Lohela-Karlsson, Charlotte Leboeuf-Yde, and Iben Axén
Unit of Intervention and Implementation Research,
Karolinska Institutet,
Institute of Environmental Medicine,
Nobels v 13, S-171 77
Stockholm, Sweden.
BACKGROUND: It has been proposed that an episode of low back pain (LBP) be defined as: “a period of pain in the lower back lasting for more than 24 h preceded and followed by a period of at least 1 month without LBP”. Previous studies have tested the definition in the general population and in secondary care populations with distinctly different results. The objectives of this study (in a primary care population) were to investigate the prevalence of 1) the number of consecutive weeks free from bothersome LBP, 2) the prevalence of at least four consecutive weeks free from bothersome LBP at any time during the study period, and 3) the prevalence of at least four consecutive weeks free from bothersome LBP at any time during the study period among subgroups that reported >30 days or ≤30 days of LBP the preceding year.
METHOD: In this prospective multicentre study subjects with LBP (n = 262) were consecutively recruited from chiropractic primary care clinics in Sweden. The number of days with bothersome LBP was collected through weekly automated text messages. The maximum number of weeks in a row without bothersome LBP and the number of periods of at least four consecutive weeks free from bothersome LBP was counted for each individual and analysed as proportions.
RESULTS: Data from 222 recruited subjects were analysed, of which 59 % reported at least one period of four consecutive weeks free from bothersome LBP. The number of consecutive pain free weeks ranged from 82 (at least one) to 31 % (9 or more). In subjects with a total duration of LBP of ≤30 days the previous year, 75 % reported a period of 4 consecutive weeks free from bothersome LBP during the study period whereas this was reported by only 48 % of subjects with a total duration of LBP of >30 days the previous year.
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CONCLUSION: Prevalence of four consecutive pain free weeks is found in the majority of subjects in this population logically reflects duration of LBP within the sample and may be applied on patients in primary care to demarcate a LBP episode.
KEYWORDS: Absence; Chiropractic; Definition; Demarcation; Episode; LBP; Low back pain; Non-episode; Primary care; Recovery
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Background
Low back pain (LBP) is a prevalent condition [1, 2] often with an intermittent course [3, 4] with episodic flare-ups [5, 6] and periods without pain. [7, 8] A definition of what constitutes an episode of LBP is fundamental for the study of new episodes, risk factors, resolution, persistence and recurrence. [9] To specify when one episode ends and a new one begins, a period free from pain (in previous research described as a “non-episode” [7, 8]) is required. Recovery is a term that may be used to demarcate such a period with absence of pain following or preceding an episode of LBP. However, there is no evidence-based definition of recovery [10] to date. Such a definition would aid in the exploration of pain trajectories to subgroup individuals and possibly tailor interventions accordingly.
De Vet et al. [9] proposed a definition of an episode of LBP based on an extensive literature search and group discussions with researchers and clinicians. They proposed that an episode of LBP be defined as: “a period of pain in the lower back lasting for more than 24 h preceded and followed by a period of at least 1 month without LBP”. In a recent [11] modified Delphi approach, it was agreed to incorporate de Vet’s definition into the consensus definition of recovery.
Leboeuf-Yde et al. [7] investigated if part of de Vet’s proposed definition, namely “at least 1 month without LBP” was applicable in two populations of LBP patients from secondary care. Using weekly data, the prevalence of periods of at least four consecutive weeks free from bothersome LBP was determined. It was found that only 18 and 20% of the patients reported at least one period of a minimum of four consecutive weeks free from bothersome LBP during the 1–year study period.
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