Contrary to current guidelines and common belief, new research published in The British Medical Journal has shown that recovery from low back pain is much slower than previously thought and even slower again for those with a compensable injury.
Australian researchers at The George Institute for International Health proved that prognosis from acute (or recent) lower back pain is not as favourable as claimed in clinical practice guidelines and challenges the common belief that 90% of patients recover within four to six weeks, with our without treatment.
"These are extremely important results because they confirm that low back pain is a significant health problem and that there is substantial room for improvement in its management," said Professor Maher. "We found that recovery from low back pain was typically much slower than previously reported - nearly one third of patients did not recover from the original episode within a year."
Professor Chris Maher, The George Institute, Australia and colleagues studied 973 patients with acute low back pain for one year. Each was managed by their preferred clinician; a doctor, physiotherapist or chiropractor, who followed treatment guidelines established by Australia's National Health and Medical Research Council (NHMRC).
These new findings show that even with treatment, after two months only 50% had fully recovered from the original episode of pain. At one year about 40% reported that their back was still causing them pain.
"These results challenge the accepted view that recovery is rapid following an episode of acute low back pain. For many people back pain becomes a long-term problem that severely impacts their life. This is despite receiving what we think is the best possible care. We clearly need to rethink our approach," Professor Maher added.
The strongest predictor of delayed recovery was if the episode of low back pain was compensable: compensation halved the chances of recovery.
"The results also highlight that we should review our compensation system because people within this system do much worse than those outside of it."
In 2005 the additional health care expenditure due to spine problems was estimated to be US$86 billion or 9% of USA health expenditure .
(i) Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingworth W, et al. Expenditures and health status among adults with back and neck problems. JAMA. 2008 Feb 13;299(6):656-64.