RRS Education Chiropractic BLOG - Musculoskeletal Research Reviews

 
Low back pain is the leading cause of disability Treatment for LBP and spine-related disorders, typically delivered in primary care and ambulatory care settings, now represent the most expensive medical problem in the United States and elsewhere!
 
Recent evidence has challenged the hypothesis that acute LBP resolves within three months. For example, a recent systematic review has indicated that 2-48% of patients with acute LBP in primary care settings transition to chronic LBP (the variability arises from heterogeneity among study populations and variance in how chronic LBP is defined). Clinical guidelines consistently recommend education and reassurance in the management of acute LBP, along with advice to maintain activity as tolerated. Recently, non-pharmacologic interventions such as heat, massage, acupuncture and spinal manipulation have been recommended as first-line management options. Initial use of diagnostic imaging, specialty consultation and prescription of opioid medications in the absence of red flags is not recommended, as such non-concordant care can lead to direct and indirect harms through increased medicalization and unnecessary health care utilization. Evidence indicates that guideline-concordant care has not been successfully implemented in primary care; however, the association of non-concordant care with the transition from acute to chronic LBP remains unclear.
 
The National Institute of Health (NIH) Task Force Pain Consortium has developed a standardized definition and research standards for chronic LBP, as well as recommended further study of prognostic instruments, such as the Subgroups for Targeted Treatment (STarT) Back Tool (SBT). The SBT is a 9-item instrument designed to identify patients with LBP at risk of persistent functional limitations but has not been investigated as a prognostic tool for the transition from acute to chronic LBP.
 
The aims of this large, multisite inception cohort study were to obtain estimates of the transition from acute to chronic LBP, assess the prognostic capabilities of the SBT and identify pragmatic factors associated with poor outcomes. Patients with acute LBP who were seen in primary care settings were prospectively enrolled, administered the SBT at baseline and assessed for chronic LBP at six months using the NIH Task Force definition. The objectives for this study were to assess the association between risk of transition from acute to chronic LBP with: 1) baseline SBT risk strata; 2) patient demographics, clinical characteristics and practice characteristics; and 3) guideline non-concordant processes of care.
 
THIS WEEK'S RESEARCH REVIEW: “Risk Factors for Transitioning from Acute to Chronic Low Back Pain”
 
This paper was published in JAMA Network Open (2021) and this Review is posted in Recent Reviews, Low Back Pain and the 2021 Archive.
 
 
Risk factors
 

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