Dataset Information

The natural course of low back pain: a systematic critical literature review.

ABSTRACT:

Background

Most patients in the secondary care sector consulting for low back pain (LBP) seem to have a more or less constant course of pain during the ensuing year. Fewer patients with LBP in the primary care sector report continual pain over a one-year period. However, not much is known about the long-term course of LBP in the general population. A systematic critical literature review was undertaken in order to study the natural course of LBP over time in the general population.

Methods

A search of articles was performed in Pubmed, Cinahl and Psychinfo using the search terms 'epidemiology'; 'low back pain' or 'back pain'; 'prospective study' or 'longitudinal study'; 'follow-up', 'natural course', 'course' or 'natural history'; 'general population' or 'working population'. Inclusion criteria were that one of the objectives was to study the course of (L)BP in the adult population, that the period of follow-up was at least 3 months, and that there were three points of observation or more. The review was undertaken by two independent reviewers using three checklists relating to description of studies, quality and outcomes. The course of LBP was established in relation to those who, at baseline, were reported not to have LBP or to have LBP. Would this course be stable, fluctuating, worsening, or improving over time? A synthesis of results in relation to common patterns was presented in a table and interpreted in a narrative form.

Results

Eight articles were included. Articles were different on time span, the number of surveys, and the definition of LBP. In six of the seven relevant studies, for those with no LBP at baseline, relatively substantial stable subgroups of people who continued to be LBP free were identified. In six of the seven relevant studies, definite stable subgroups of continued LBP were noted and improvement (becoming pain free) was never reported to be a common finding.

Conclusion

The status of LBP in individuals of the general population appears to be relatively stable over time, perhaps particularly so for those without LBP at baseline.

SUBMITTER: Lemeunier N

PROVIDER: S-EPMC3599187 | biostudies-literature | 2012 Oct

REPOSITORIES: biostudies-literature

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Publications

The natural course of low back pain: a systematic critical literature review.

Lemeunier Nadège N Leboeuf-Yde Charlotte C Gagey Olivier O

Chiropractic & manual therapies 20121017 1

<h4>Background</h4>Most patients in the secondary care sector consulting for low back pain (LBP) seem to have a more or less constant course of pain during the ensuing year. Fewer patients with LBP in the primary care sector report continual pain over a one-year period. However, not much is known about the long-term course of LBP in the general population. A systematic critical literature review was undertaken in order to study the natural course of LBP over time in the general population.<h4>Me ...[more]

PMID: 23075327

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Project description:Background:Taking the natural course of recurrent and fluctuating low back pain (LBP) seen in longitudinal studies of adults into consideration, the aetiology and development of LBP in children and adolescents also needs to be reflected in a long-term course. Therefore, a systematic critical literature review was undertaken to assess the natural course of LBP in the general population from childhood through adolescence to young adulthood. Methods:A systematic literature search was conducted in MEDLINE, EMBASE, CINAHL and PsycINFO with synonyms of search terms for 1) low back pain; 2) natural course; 3) cohort study and 4) children. Records in English, German, French, Danish, Swedish, and Norwegian were included. To assess the methodological quality of the studies, the NIH quality assessment checklist for cohort studies was adapted and risk of bias was assessed on a study level. Two authors independently reviewed selected studies, assessed quality, and extracted data. A synthesis of results in relation to the natural course of LBP was created. Results:Totally, 3373 records were identified, eight articles were included for quality assessment, and finally, four studies of good to fair quality were included for synthesis of results. Indication of three common patterns of LBP were identified across studies and labelled as 1) ´children and adolescents with no LBP or low probability of LBP´ (49 to 53%), 2) ´children and adolescents with fluctuation of LBP´ (16 to 37%) and 3) ´children and adolescents with repeated reporting of LBP´ (< 1 to 10%). Conclusion:Although methodological heterogeneity, mainly due to different age ranges, an indication of a natural course of LBP was seen across studies. The majority of children and adolescents repeatedly reporting no or low probability of LBP. With recall periods between one week to three months and sampling rates ranging from one to four years, a very low rate repeatedly reported LBP, and approximately one-fifth to one-third of children and adolescents had fluctuating reports of LBP. A need of future research of LBP trajectories with short reporting period lengths and narrower sampling windows in a long-term perspective is emphasized in order to study childhood influences on the development of LBP throughout life.

Project description:Background and objectiveThe current treatments of primary musculoskeletal low back pain (LBP) have a low to moderate efficacy, which might be improved by looking at the contribution of placebo effects. However, the size of true placebo effects in LBP is unknown. Therefore, a systematic review and meta-analysis were executed of randomized controlled trials investigating placebo effects in LBP.Databases and data treatmentThe study protocol was registered in the international prospective register of systematic reviews Prospero (CRD42019148745). A literature search (in PubMed, Embase, The Cochrane Library, CINAHL and PsycINFO) up to 2021 February 16th yielded 2,423 studies. Two independent reviewers assessed eligibility and risk of bias.ResultsEighteen studies were eligible for the systematic review and 5 for the meta-analysis. Fourteen of the 18 studies were clinical treatment studies, and 4 were experimental studies specifically assessing placebo effects. The clinical treatment studies provided varying evidence for placebo effects in chronic LBP but insufficient evidence for acute and subacute LBP. Most experimental studies investigating chronic LBP revealed significant placebo effects. The meta-analysis of 5 treatment studies investigating chronic LBP depicted a significant moderate effect size of placebo for pain intensity (SMD = 0.57) and disability (SMD = 0.52).ConclusionsThis review shows a significant contribution of placebo effects to chronic LBP symptom relief in clinical and experimental conditions. The meta-analysis revealed that placebo effects can influence chronic LBP intensity and disability. However, additional studies are required for more supporting evidence and evidence for placebo effects in acute or subacute LBP.SignificanceThis systematic review and meta-analysis provides evidence of true placebo effects in low back pain (LBP). It shows a significant contribution of placebo effects to chronic LBP symptom relief. The results highlight the importance of patient- and context-related factors in fostering treatment effects in this patient group. New studies could provide insight into the potential value of actively making use of placebo effects in clinical practice.

Project description:BackgroundProprioceptive training (PrT) is popularly applied as preventive or rehabilitative exercise method in various sports and rehabilitation settings. Its effect on pain and function is only poorly evaluated. The aim of this systematic review was to summarise and analyse the existing data on the effects of PrT on pain alleviation and functional restoration in patients with chronic (? 3 months) neck- or back pain.MethodsRelevant electronic databases were searched from their respective inception to February 2014. Randomised controlled trials comparing PrT with conventional therapies or inactive controls in patients with neck- or low back pain were included. Two review authors independently screened articles and assessed risk of bias (RoB). Data extraction was performed by the first author and crosschecked by a second author. Quality of findings was assessed and rated according to GRADE guidelines. Pain and functional status outcomes were extracted and synthesised qualitatively and quantitatively.ResultsIn total, 18 studies involving 1380 subjects described interventions related to PrT (years 1994-2013). 6 studies focussed on neck-, 12 on low back pain. Three main directions of PrT were identified: Discriminatory perceptive exercises with somatosensory stimuli to the back (pPrT, n=2), multimodal exercises on labile surfaces (mPrT, n=13), or joint repositioning exercise with head-eye coordination (rPrT, n=3). Comparators entailed usual care, home based training, educational therapy, strengthening, stretching and endurance training, or inactive controls. Quality of studies was low and RoB was deemed moderate to high with a high prevalence of unclear sequence generation and group allocation (>60%). Low quality evidence suggests PrT may be more effective than not intervening at all. Low quality evidence suggests that PrT is no more effective than conventional physiotherapy. Low quality evidence suggests PrT is inferior to educational and behavioural approaches.ConclusionsThere are few relevant good quality studies on proprioceptive exercises. A descriptive summary of the evidence suggests that there is no consistent benefit in adding PrT to neck- and low back pain rehabilitation and functional restoration.

Project description:BackgroundPrevious systematic reviews have reported positive associations between Modic changes (MCs) and low back pain (LBP), but due to their narrow scope and new primary studies, there is a need for a comprehensive systematic review. Our objectives were to investigate if MCs are associated with non-specific LBP and/or activity limitation and if such associations are modified by other factors.MethodsA protocol for this review was registered at PROSPERO prior to commencing the work (PROSPERO record: CRD42015017350). The MEDLINE, CINAHL and EMBASE databases were searched for relevant studies from first record to June 15th 2016. Prospective or retrospective cross-sectional cohort studies and case-control studies including people of all ages from general, working and clinical study populations were eligible for inclusion. Risk of bias assessment and data extraction for associations and potential modifiers were completed independently by pairs of reviewers. Meta-analysis was performed for homogeneous studies and presented as odds ratios (OR) with 95% CI.ResultsIn all, 5210 citations were identified and 31 studies were included. One study had low risk of bias. Fifteen studies (48%) reported statistically significant positive associations between MCs and LBP and one study found a statistically significant negative association. Meta-analysis performed for studies using concordant pain with provocative discography as the clinical outcome resulted in an OR of 4.01 (1.52-10.61). One of seven studies reported a statistically significant positive association between MCs and activity limitation. Lumbar disc level and disc degeneration were found to modify the association between MCs and LBP.ConclusionsThe results from this comprehensive systematic review indicate that the associations between MCs and LBP-related outcomes are inconsistent. The high risk of bias and the heterogeneity in terms of study samples, clinical outcomes and prevalence estimates of MCs and LBP may explain these findings. It is likely that new studies with low risk of bias will affect the direction and strength of these associations.

Project description:BackgroundBack pain is a frequent health problem in the general population. The epidemiology of back pain in the general population is well researched, but detailed data on the prevalence and risk factors of back pain in athletes are rare.ObjectiveThe primary objective was to review articles about back pain in athletes to provide an overview of its prevalence in different sports and compare its prevalence among various types of sports and the general population.Data sourcesA comprehensive search of articles published through May 2015 was conducted. Two independent reviewers searched six databases from inception (PubMed®, Embase, MEDLINE®, Cochrane Library, PsycINFO and PSYNDEX), using specifically developed search strategies, for relevant epidemiological research on back pain in 14- to 40-year-old athletes of Olympic disciplines. The reviewers independently evaluated the methodological quality of reviewed articles meeting the inclusion criteria to identify potential sources of bias. Relevant data were extracted from each study.ResultsForty-three articles were judged to meet the inclusion criteria and were included in the assessment of methodological quality. Of these, 25 were assessed to be of high quality. Lifetime prevalence and point prevalence were the most commonly researched episodes and the lower back was the most common localization of pain. In the high-quality studies, lifetime prevalence of low back pain in athletes was 1-94%, (highest prevalence in rowing and cross-country skiing), and point prevalence of low back pain was 18-65% (lowest prevalence in basketball and highest prevalence in rowing).ConclusionThe methodological heterogeneity of the included studies showed a wide range of prevalence rates and did not enable a detailed comparison of data among different sports, within one discipline, or versus the general population. Based on the results of this review, however, it seems obvious that back pain requires further study in some sports.

Dataset Information

The natural course of low back pain: a systematic critical literature review.

Background

Methods

Results

Conclusion

Publications

The natural course of low back pain: a systematic critical literature review.

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