Background & Aims

Low back pain (LBP) is a highly prevalent musculoskeletal health problem, which causes a high global disability (1) and is a common reason for seeking primary care. The clinical presentation of chronic LBP (CLBP), with a duration longer than 12 weeks, is associated with variations of recurrent or persistent pain with varying impact on body functions, activity and, participation in daily life (2). Pain severity can be regarded as a continuum ranging from no pain to regional pain to widespread pain with variations in between, and persons have been found to transit in both ways between different severities of pain over time (3). Studies of the clinical course over a long period and factors that promote improvements in pain and functional development of CLBP, are warranted (4,5,6). A cohort of women with CLBP have been followed-up after 2-years (7,8,9). This study aimed to investigate change in pain after 13-years in this cohort.

Methods

A 13-year prospective longitudinal cohort study of women with CLBP in primary care. The same study protocol was used at baseline, after 2 and 13 years. The assessment included standard questions about history of CLBP, socio-demographic data, comorbidity, and treatment. The participants performed three physical capacity tests and completed several questionnaires of patient reported outcome measures. For pain; pain history, pain intensity (Visual Analog Scale (VAS) 0-100 mm), how pain impact daily life (VAS 0-100 mm), pain localisations, and pain pressure threshold were assessed.

Results

At the 13-year follow-up, 67 % (87/130) of the participants could be assessed. Mean-age at baseline was 46 (SD 11) years, and mean duration of CLBP at baseline was 9.8 (SD 8.9) years. At the 13-year follow-up, statistically significant (p<0.05) improvement was shown in pain intensity (VAS) -9.7 (SD 28) mm and how pain impact daily life (VAS) -11 (SD 31) mm. Forty percent (n= 34/86) of the women showed a 50% improvement pain intensity from baseline.

Conclusions

Over a period of 13 years, half of the women showed a positive course in pain intensity and the experience of how pain impact daily life was improved. Findings which can be communicated in primary care and give guidance for future interventional trials.

References

1. Wu A, March L, Zheng X, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: Estimates from the Global Burden of Disease Study 2017. Ann. Transl. Med. 2020;8:299.
2. Kongsted A, Kent P, Axen I, et al. What have we learned from ten years of trajectory research in low back pain? BMC Musculoskel Disord. 2016;17:220
3. Viniol A, Jegan N, Brugger M, et al. Even Worse – Risk Factors and Protective Factors for Transition from Chronic Localized Low Back Pain to Chronic Widespread Pain in General Practice: A Cohort Study. Spine. 2015;40(15):E890-9.
4. Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968-74.
5. Statens beredning för medicinsk utvärdering (SBU). Preventiva insatser vid akut smärta från rygg och nacke. En systematisk översikt och utvärdering av medicinska, hälsoekonomiska och etiska aspekter. SBU-rapport nr 245:2016, Stockholm.
6. Verkerk K, Luijsterburg PA, Miedema HS, et al. Prognostic factors for recovery in chronic nonspecific low back pain: a systematic review. Phys Ther. 2012;92(9):1093-108.
7. Nordeman L, Gunnarsson R, Mannerkorpi K. Prevalence and characteristics of widespread pain in female primary health care patients with chronic low back pain. Clin J Pain. 2012;28(1):65-72.
8. Nordeman L, Gunnarsson R, Mannerkorpi K. Prognostic factors for work ability in women with chronic low back pain consulting primary health care: a 2-year prospective longitudinal cohort study. Clin J Pain. 2014;30(5):391-8.
9. Nordeman L, Thorselius L, Gunnarsson R, et al. Predictors for future activity limitation in women with chronic low back pain consulting primary care: a 2-year prospective longitudinal cohort study. BMJ open. 2017;7(6):e013974.

Presenting Author

Lena Nordeman

Poster Authors

Lena Nordeman

associate professor

Research Education Development and Innovation in primary care, Region Vastra Gotaland

Lead Author

E-mail

Chan-Mei Ho-Henriksson

PhD

Institute of Neuroscience and Physiology, University of Gothenburg, Sweden

Lead Author

E-mail

Elisabeth Enhörning

Närhälsan Primary Care Rehabilitation, Region Västra Götaland, Uddevalla, Sweden

Lead Author

E-mail

Anna Grimby

School of Public Health and Community Medicine, Department of Med., Gothenburg Univ

Lead Author

E-mail

Margareta Hellgren

School of Public Health and Community Medicine, Inst of Medicine, University of Gothenburg, Sweden

Lead Author

E-mail

Anna Bergenheim

Region Västra Götaland

Lead Author

E-mail

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Low Back Pain