PainRelief.com Interview with:
Prof. Lorimer Moseley PhD
DSc, FAAHMS, FACP, HonFFPMANZCA, HonMAPA, BAppSc(Phty)(Hons)
Professor of Clinical Neurosciences
Foundation Chair in Physiotherapy
University of South Australia
Chair of PainAdelaide Stakeholders’ Consortium
PainRelief.com: What is the background for this study?
Response: 12 years ago, members of our group gathered all the research studies that had followed people with back pain for a year and used all the combined data to get an idea of how well people with back pain do. That big study concluded that if you have had back pain for less than 6 weeks, you were highly likely to do really well and that if you had back pain for more than 6 weeks, things were still likely to go pretty well. That made us think ’so why do so many people have chronic back pain?’
Perhaps, by lumping sub-acute back pain (6-12 weeks) in with chronic back pain (>12 weeks) that study 12 years ago made outcomes for people with over 12 weeks of back pain look better than they really were. We decided to repeat that big study from 12 years ago but because there were likely to be many more research studies, we decided to divide the participants into three groups: those with back pain for less than 6 weeks, those with back pain for 6-12 weeks and those with back pain for more than 12 weeks.
PainRelief.com: What should readers take away from your report?
Response: There is good news and some challenging news. First up – if you have back pain for <6 weeks, you are still highly likely to recover. If you have back pain for between 6 and 12 weeks, your chances are not quite as good but you are still very likely to recover.
The challenging bit is that if you have already had back pain for 12 weeks, your chance of recovery within a year is much lower. This new result fits with the data showing a large number of people have chronic back pain.
PainRelief.com: What recommendations do you have for future research as a result of this study?
Response: While the data leave us quite certain that outcomes from acute and sub-acute back pain are in general very good, there was much less data for chronic and that means we are not quite as certain about that result. So, we need more data for people who have already had back pain for more than 3 months and we need to follow-up those people really well. That people with chronic back pain are not showing high recovery rates is very important, for two reasons. First, there are treatments emerging that clearly show recovery is possible and research is required to work out how to get these treatments to people with chronic back pain. Those treatments are grounded in helping people reframe the problem of back pain, from one of a single pathology or vulnerability to a broader problem that may have many and individually-specific contributing factors. So, we actually KNOW the best treatments for chronic pain involve education and training both brain and body back to normal function, but, unfortunately, we also know that most people with chronic pain are not receiving these treatments.
The body of evidence shows that pain education has the most sustainable benefits for people with chronic back pain, but most health professionals don’t see education as an intervention. Either that or they just don’t feel confident delivering it. So, we need research into the best ways to equip health professionals to deliver best care for chronic back pain and we need research into the best ways to give access to this care to everyone who needs it.
The second reason the low recovery rate is important is that we need to keep pursuing more effective care and better ways of intervening effectively BEFORE back pain becomes chronic. I believe we don’t need any more clinical trials comparing a treatment to usual care but we do need clinical trials the explain why and how things work, so we can make them better.
Additional comments from Dr Sarah Wallwork PhD, lead author:
Dr. Wallwork is aResearch Fellow in IIMPACT in Health
University of South Australia in the field of Paediatric Pain
The only thing I would add would be that these trajectories are specific to adult populations (18-60 years of age). Unfortunately there is no data on the trajectory of low back pain in children and adolescents, for which back pain is also very common, so there is a huge need to better understand the course of low back pain in these younger populations. Additionally, while there is some evidence to suggest that people aged over 60 years have poorer outcomes than those less than 60 years, we didn’t have enough data to support or refute these claims, so this is another area that certainly warrants future research.
Disclosures: I receive royalties from books about pain education and am part of a team that is developing these new treatments for chronic back pain to which I refer.
Citation:
The clinical course of acute, subacute and persistent low back pain: a systematic review and meta-analysis
Sarah B. Wallwork, Felicity A. Braithwaite, Mary O’Keeffe, Mervyn J. Travers, Simon J. Summers, Belinda Lange, Dana A. Hince, Leonardo O.P. Costa, Luciola da C. Menezes Costa, Belinda Chiera and G. Lorimer Moseley
CMAJ January 22, 2024 196 (2) E29-E46; DOI: https://doi.org/10.1503/cmaj.230542
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Last Updated on January 25, 2024 by PainRelief.com