In response to these variances in definitions of recurrence, the investigators from Australia designed this study to answer the questions of the frequency of recurrence and the risk factors for developing recurrent episodes. A subject eligible for the study had an episode of pain for at least 24 hours but less than six weeks in the lumbar region and was preceded by a period of at least one month without back pain. The date of recovery was defined as the first day of a pain-free period of one month. Participants were asked about the development of pain at three months and 12 months and recall of back pain of at least 24 hours’ duration at 12 months. Baseline characteristics of the patients were obtained for multivariate analysis to identify factors predictive for recurrence.
Of an inception cohort of 1,334 patients with acute LPB, 353 recovered by the six-week follow-up. An interesting finding of the study that is not discussed is the almost 1,000 individuals with LBP who did not have a resolution of symptoms at six weeks. The exclusion of these individuals did not have an effect on the study results since the goal of the current study was the frequency of recurrence not the natural history of LBP recovery. Excluding these individuals affirmed the study group to be homogenous in having LBP that resolved in a timely fashion. The one-year incidence of recurrence based on recall at 12 months was 24%. When using pain assessments at three and 12 months, the one-year incidence of recurrence of LBP increased to 38%. An impressive component of the study results was the 100% follow-up rate over a 12-month period. A list of the factors examined for risk of recurrence is shown in Table 1, below. Of all the factors listed, an episode of back pain prior to entrance in the study was the sole factor with predictive value.
Overall this study has good and not-so-good news for individuals with LBP. This study offers some good news for individuals with an episode of LBP in that only about a quarter of individuals will have a recurrence of pain over a subsequent 12-month period. This recurrence rate is one of the lowest reported in medical literature. These findings pertain to individuals who are in their mid 40s and who have soft tissue problems of the lumbar spine. It does not pertain to individuals with herniated discs or spinal stenosis. The disheartening news is that LBP is the gift that keeps on giving. If you have had it once, you are at risk for a subsequent attack just because you had a previous attack. This is part of the story that cannot be modified to decrease risk. This study tells us that the best way of preventing recurrences is to prevent LBP episodes in the first place. In an attempt to decrease the risk of LBP episodes in individuals, I recommend core strengthening exercises to build up paraspinous and abdominal muscles. Using proper lifting techniques such as facing the object and using leg power can avoid the twisting injury that can be the cause of a sustained LBP episode
