BACKGROUND: Although low-back pain is a highly prevalent condition, its clinical course remains uncertain. Our main objective was to systematically review the literature on the clinical course of pain and disability in patients with acute and persistent low-back pain. Our secondary objective was to investigate whether pain and disability have similar courses. METHODS: We performed a meta-analysis of inception cohort studies. We identified eligible studies by searching MEDLINE, Embase and CINAHL. We included prospective studies that enrolled an episode-inception cohort of patients with acute or persistent low-back pain and that measured pain, disability or recovery. Two independent reviewers extracted data and assessed methodologic quality. We used mixed models to determine pooled estimates of pain and disability over time. RESULTS: Data from 33 discrete cohorts (11 166 participants) were included in the review. The variance-weighted mean pain score (out of a maximum score of 100) was 52 (95% CI 48-57) at baseline, 23 (95% CI 21-25) at 6 weeks, 12 (95% CI 9-15) at 26 weeks and 6 (95% CI 3-10) at 52 weeks after the onset of pain for cohorts with acute pain. Among cohorts with persistent pain, the variance-weighted mean pain score (out of 100) was 51 (95% CI 44-59) at baseline, 33 (95% CI 29-38) at 6 weeks, 26 (95% CI 20-33) at 26 weeks and 23 (95% CI 16-30) at 52 weeks after the onset of pain. The course of disability outcomes was similar to the time course of pain outcomes in the acute pain cohorts, but the pain outcomes were slightly worse than disability outcomes in the persistent pain cohorts. INTERPRETATION: Patients who presented with acute or persistent low-back pain improved markedly in the first six weeks. After that time improvement slowed. Low to moderate levels of pain and disability were still present at one year, especially in the cohorts with persistent pain.
BACKGROUND: Although low-back pain is a highly prevalent condition, its clinical course remains uncertain. Our main objective was to systematically review the literature on the clinical course of pain and disability in patients with acute and persistent low-back pain. Our secondary objective was to investigate whether pain and disability have similar courses. METHODS: We performed a meta-analysis of inception cohort studies. We identified eligible studies by searching MEDLINE, Embase and CINAHL. We included prospective studies that enrolled an episode-inception cohort of patients with acute or persistent low-back pain and that measured pain, disability or recovery. Two independent reviewers extracted data and assessed methodologic quality. We used mixed models to determine pooled estimates of pain and disability over time. RESULTS: Data from 33 discrete cohorts (11 166 participants) were included in the review. The variance-weighted mean pain score (out of a maximum score of 100) was 52 (95% CI 48-57) at baseline, 23 (95% CI 21-25) at 6 weeks, 12 (95% CI 9-15) at 26 weeks and 6 (95% CI 3-10) at 52 weeks after the onset of pain for cohorts with acute pain. Among cohorts with persistent pain, the variance-weighted mean pain score (out of 100) was 51 (95% CI 44-59) at baseline, 33 (95% CI 29-38) at 6 weeks, 26 (95% CI 20-33) at 26 weeks and 23 (95% CI 16-30) at 52 weeks after the onset of pain. The course of disability outcomes was similar to the time course of pain outcomes in the acute pain cohorts, but the pain outcomes were slightly worse than disability outcomes in the persistent pain cohorts. INTERPRETATION:Patients who presented with acute or persistent low-back pain improved markedly in the first six weeks. After that time improvement slowed. Low to moderate levels of pain and disability were still present at one year, especially in the cohorts with persistent pain.
Authors: Anaïs Lacasse; Jean-Sébastien Roy; Alexandre J Parent; Nioushah Noushi; Chúk Odenigbo; Gabrielle Pagé; Nicolas Beaudet; Manon Choinière; Laura S Stone; Mark A Ware Journal: CMAJ Open Date: 2017-03-10
Authors: Bruno T Saragiotto; Gustavo C Machado; Manuela L Ferreira; Marina B Pinheiro; Christina Abdel Shaheed; Christopher G Maher Journal: Cochrane Database Syst Rev Date: 2016-06-07
Authors: L Susan Wieland; Nicole Skoetz; Karen Pilkington; Ramaprabhu Vempati; Christopher R D'Adamo; Brian M Berman Journal: Cochrane Database Syst Rev Date: 2017-01-12
Authors: Samantha J Demarchi; Crystian B Oliveira; Marcia R Franco; Priscila K Morelhão; Thalysi M Hisamatsu; Fernanda G Silva; Tatiana M Damato; Rafael Z Pinto Journal: Eur Spine J Date: 2019-05-03 Impact factor: 3.134
Authors: Giulia Norton; Christine M McDonough; Howard J Cabral; Michael Shwartz; James F Burgess Journal: Spine J Date: 2015-08-14 Impact factor: 4.166
Authors: Carolina G Fritsch; Manuela L Ferreira; Christopher G Maher; Robert D Herbert; Rafael Z Pinto; Bart Koes; Paulo H Ferreira Journal: Eur Spine J Date: 2016-07-21 Impact factor: 3.134