What If You Don't Go See a Doctor for the Low Back Pain?What happens to people who have chronic low back pain but don't go see a doctor or get medical treatment? Does it eventually go away on its own? This may be the first study ever to report on the natural history of untreated low back pain. The information comes from Switzerland where large population-based studies are popular.
Large numbers of people participate in group studies of this type. They fill out diaries with information of interest to the researchers. They have regular follow-up assessments.
This particular study was designed to observe the musculoskeletal health of over 16,000 people. Four hundred of those individuals reported having low back pain. The information they provided was used to analyze them as a subgroup.
None of these people with low back pain went to their physician or got any medical treatment for the problem. That was their decision -- it wasn't a requirement of the study. But they agreed to be part of the study and fill out some additional diaries and surveys week-by-week for a full calendar year.
They answered questions about their work, daily life, and participation in sports or recreational activities. They documented their pain level, medication use, and work or social limitations caused by the back pain.
After analyzing all the data collected, the 400 participants appeared to fall into one of four groups. These four clusters included people with: 1) severe persistent pain, 2) moderate persistent pain, 3) fluctuating pain, and 4) mild persistent pain.
Most of the people were in groups 2 and 3 (moderate or fluctuating pain). About 10 per cent were in the severe group. This may be the smallest group because people with severe low back pain usually seek help. The last 20 per cent were in the mild persistent category.
The groups were very even (similar) in terms of weight, activity level, education, location (urban or rural residence), and general health. The biggest difference noted was age -- younger people had more mild pain, whereas older folks were more likely to report severe pain.
By looking at what the participants in all four groups wrote in their diaries, the researchers were able to see that after a year, most people had less pain but no one was in a recovered group. There was some cross-over from group to group.
Cross-over refers to people who started out in one group and ended up in another. Cross-over occurs when anyone changed from one group to another based on frequency, intensity, and duration of painful symptoms. So for example, someone with mild pain ended up in the severe pain group or people with moderate pain improved enough to fall into the mild group.
Individuals in the moderate persistent group were the least likely to cross-over into a different group. The authors suggested they remained in the moderate persistent category because they did not seek medical help or treatment. Perhaps if their back pain got worse and became more severe, they would have gone to their doctors. People in the fluctuating group were the most likely to change groups.
The authors conclude this is the first large study of its kind. From the results of this study, it looks like the natural course of chronic and recurrent (untreated) low back pain is one of shifting patterns.
Patients move in and out of different phases of low back pain. Untreated low back pain tends to fall into one of the four pain patterns described. And although there is cross-over, most people still had back pain a year later.
Oezguer Tamcan, et al. The Course of Chronic and Recurrent Low Back Pain in the General Population. September 2010. Vol. 150. No. 3. Pp. 451-457.
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