Low back pain is a leading cause of disability worldwide, with more than 570 million people affected. In the United States alone, health care spending for low back pain was $134.5 billion between 1996 and 2016, and the cost is rising.
“The good news is that most episodes of back pain get better, even if you’ve had back pain for a few months,” says University of South Australia professor Lorimer Moseley.
“The bad news is that once you’ve had back pain for more than a few months, the chance of recovery is much less. This reminds us that although almost everyone experiences back pain, some people do better than others, but we we don’t, I totally understand why.”
The systematic review and meta-analysis, conducted by an international team of researchers, included 95 studies aimed at understanding the clinical course of acute (< 6 weeks), subacute (6 to less than 12 weeks) and persistent (12 to less than 52 weeks) lower back pain.
For people with new back pain, pain and mobility problems were significantly reduced in the first 6 weeks, but recovery slowed thereafter.
This study filled a gap in a 2012 paper by the same research team, with new findings showing that many people with persistent low back pain (more than 12 weeks) continue to have moderate to high levels of pain and disability.
“These findings make it clear that back pain can persist even after the original injury has healed,” says Professor Moseley.
“In these cases, back pain is related to hypersensitivity of the pain system, not ongoing back injury. This means that if you have chronic back pain — back pain most days for more than a few months — then it’s time to take a new approach to getting better.”
He notes that there are new treatments based on training both the brain and the body that “focus on first understanding that chronic back pain is not a simple problem, so it doesn’t have a simple solution, and then gradually reducing the sensitivity of the pain system while increasing your function and participation in meaningful activities.”
The authors report that identifying slowing of recovery in people with subacute low back pain is important so that care can be escalated and the likelihood of persistent pain reduced.
Further research is needed into treatments to help treat this common and debilitating condition and to better understand it in people aged under 18 and over 60.