Background & Aims
Non-specific low back pain is a prevalent and debilitating condition that generates high socioeconomic costs1,2. Although clinical guidelines recommend active interventions and pain education in primary care3,4, the proportion of emergency department visits related to low back pain is similar to colds, fever, and respiratory problem5. Furthermore, most emergency department visits for spinal pain are related to non-specific chronic low back pain6,7. Prognostic studies show that 42% of patients with non-specific chronic back pain in primary care and 73% patients with acute non-specific chronic back pain in emergency departments are recovery from pain within 12 months8,9. However, there is a lack of evidence on the prognosis for non-specific chronic back pain in emergency departments, especially in low and middle-income countries. Thus, the aim of this study is to describe the prognosis of Brazilian patients with non-specific chronic low back pain from emergency departments.
Methods
This prospective inception cohort study used data from a study on the prognosis of patients with non-specific acute low back pain8. Two hundred and fifty-six patients with non-specific chronic low back pain aged 18-80 years of both sexes from four emergency departments in São Paulo, Brazil were included. Patients with pain due to nerve compression, severe pathologies (fracture, tumor, and infection), any renal condition, and inability to comprehend Portuguese were excluded. The outcomes were days to recovery from pain (the absence of pain for 30 consecutive days) and days to recovery from disability (the absence of disability for 30 consecutive days)9,10,11. Kaplan-Meier survival analysis was used to describe the prognosis of non-specific chronic low back pain for recovery from pain and disability. Survival curves were constructed using the number of days to recover from pain and disability over 9 months. The 75th percentile was used to estimate the survival time for each outcome.
Results
Patients presented severe pain on the onset of symptoms (Numerical Pain Scale [0-10], mean=8, standard deviation [SD]=2), moderate pain on the onset of chronicity (mean=6, SD=3) and at 9 months (mean=5, SD=3). Patients presented moderate disability in all time points (Roland Morris Questionnaire [0-24], mean=14, SD=7 on the onset of symptoms; and mean=12, SD=9 at 9 months). The results of the survival analyses showed that the cumulative probability was 18% (95% confidence interval [CI]=13-23) for recovery from pain and 30% (95% CI=14-23) for recovery from disability at 3 months. Furthermore, the cumulative probability for recovery from pain was 37% (95% CI=30-42) at 9 months, and for recovery from disability was 46% (95% CI=23-34) at 6 months. It was not possible to estimate the cumulative probability for recovery from disability at 9 months. Based on the 75th percentile, the days to recovery from pain and disability over 9 months were 97 days and 74 days, respectively.
Conclusions
The results of this study suggest that the prognosis is moderately optimistic for Brazilian patients with chronic low back pain from emergence departments for recovery from pain and disability over 9 months. Furthermore, patients presented moderate pain and disability from the onset of chronicity up to 9 months after the baseline assessment.
References
1. Vos T, Allen C, Arora M, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545-1602.
2. Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008;8(1):8-20.
3. Foster NE, Anema JR, Cherkin D, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(18):2368-2383.
4. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736-747.
5. O’Cathain A, Coleman P, Nicholl J. Characteristics of the emergency and urgent care system important to patients: A qualitative study. J Heal Serv Res Policy. 2008;13(SUPPL. 2):19-25.
6. Ferreira GE, Herbert R, Machado GC, et al. Low back pain presentations to New South Wales emergency departments: Trends over time and geographical variation. EMA – Emerg Med Australas. 2021;33(5):868-874.
7. Edwards J, Hayden J, Magee K, Asbridge M. LO001: The prevalence of low back pain in the emergency department: a systematic review and primary study in the Charles V. Keating Emergency and Trauma Centre, Halifax, Nova Scotia, Canada. CJEM. 2016;18(S1):S30-S30.
8. Soares Oliveira I, da Silva T, Costa LOP, et al. The Long-Term Prognosis in People With Recent Onset Low Back Pain From Emergency Departments: An Inception Cohort Study. J Pain. 2021;22(11):1497-1505.
9. Menezes Costa LDC, Maher CG, McAuley JH, et al. Prognosis for patients with chronic low back pain: Inception cohort study. BMJ. 2009;339(7725):850.
10. Henschke N, Maher CG, Refshauge KM, et al. Prognosis in patients with recent onset low back pain in Australian primary care: Inception cohort study. Bmj. 2008;337(7662):154-157.
11. Costa LOP, Maher CG, et al. Clinimetric testing of three self-report outcome measures for low back pain patients in Brazil: Which one is the best? Spine (Phila Pa 1976). 2008;33(22):2459-2463.
Presenting Author
Gisela Cristiane Miyamoto
Poster Authors
Gisela Cristiane Miyamoto
PhD
Universidade Cidade de São Paulo
Lead Author
Luiz Felício Cadete Scola
Ms
Universidade Cidade de São Paulo, São Paulo SP, Brazil
Lead Author
Tatiane da Silva Munhoz
PhD
Universidade Cidade de São Paulo, São Paulo SP, Brazil
Lead Author
Indiara Soares Oliveira
Universidade Cidade de São Paulo, São Paulo SP, Brazil
Lead Author
Lucíola Costa PhD
Universidade Cidade de São Paulo
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Low Back Pain