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Acute low back pain is marked by variability: An internet-based pilot study.

Suri P, Rainville J, Fitzmaurice GM, Katz JN, Jamison RN, Martha J, Hartigan C, Limke J, Jouve C, Hunter DJ - BMC Musculoskelet Disord (2011)

Bottom Line: A model with a quadratic trend for time best characterized improvements in pain.Pain decreased rapidly during the first 14 days after seeking care, and leveled off after about 28 days.Acute LBP is characterized by variability.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of PM&R, VA Boston Healthcare System, Boston, USA. pradeep.suri@va.gov

ABSTRACT

Background: Pain variability in acute LBP has received limited study. The objectives of this pilot study were to characterize fluctuations in pain during acute LBP, to determine whether self-reported 'flares' of pain represent discrete periods of increased pain intensity, and to examine whether the frequency of flares was associated with back-related disability outcomes.

Methods: We conducted a cohort study of acute LBP patients utilizing frequent serial assessments and Internet-based data collection. Adults with acute LBP (lasting ≤3 months) completed questionnaires at the time of seeking care, and at both 3-day and 1-week intervals, for 6 weeks. Back pain was measured using a numerical pain rating scale (NPRS), and disability was measured using the Oswestry Disability Index (ODI). A pain flare was defined as 'a period of increased pain lasting at least 2 hours, when your pain intensity is distinctly worse than it has been recently'. We used mixed-effects linear regression to model longitudinal changes in pain intensity, and multivariate linear regression to model associations between flare frequency and disability outcomes.

Results: 42 of 47 participants (89%) reported pain flares, and the average number of discrete flare periods per patient was 3.5 over 6 weeks of follow-up. More than half of flares were less than 4 hours in duration, and about 75% of flares were less than one day in duration. A model with a quadratic trend for time best characterized improvements in pain. Pain decreased rapidly during the first 14 days after seeking care, and leveled off after about 28 days. Patients who reported a pain flare experienced an almost 3-point greater current NPRS than those not reporting a flare (mean difference [SD] 2.70 [0.11]; p < 0.0001). Higher flare frequency was independently associated with a higher final ODI score (ß [SE} 0.28 (0.08); p = 0.002).

Conclusions: Acute LBP is characterized by variability. Patients with acute LBP report multiple distinct flares of pain, which correspond to discrete increases in pain intensity. A higher flare frequency is associated with worse disability outcomes.

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Related in: MedlinePlus

Example #1 of Flares During the Course of Acute Low Back Pain.
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Figure 3: Example #1 of Flares During the Course of Acute Low Back Pain.

Mentions: Multiple, discrete flares of increased pain were experienced by nearly all individuals recovering from acute LBP. Although the majority of reported flares lasted less than 24 hours, almost one quarter of flares lasted about one week. The time course of back pain improvement was curvilinear, with the majority of improvement occurring in the first two weeks after seeking care, and a leveling off of improvement after 4 weeks. However, despite the fact that pain levels were constantly changing during acute LBP, individuals were able to identify pain flares that corresponded to statistically significant increases in pain intensity as compared to other individuals not reporting flares, with a flare 'effect' of almost 3 points on the NPRS at any time during follow-up. This flare effect exceeds the threshold of 2 NPRS points commonly accepted as a minimal important change in NPRS[20]. The high degree of variability typical during acute LBP is difficult to accurately conceptualize using descriptions of flare frequency and magnitude of common pain intensity changes; Figures 3 and 4 present two examples of individual patient data that better convey the degree of variability seen during acute LBP.


Acute low back pain is marked by variability: An internet-based pilot study.

Suri P, Rainville J, Fitzmaurice GM, Katz JN, Jamison RN, Martha J, Hartigan C, Limke J, Jouve C, Hunter DJ - BMC Musculoskelet Disord (2011)

Example #1 of Flares During the Course of Acute Low Back Pain.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3198993&req=5

Figure 3: Example #1 of Flares During the Course of Acute Low Back Pain.
Mentions: Multiple, discrete flares of increased pain were experienced by nearly all individuals recovering from acute LBP. Although the majority of reported flares lasted less than 24 hours, almost one quarter of flares lasted about one week. The time course of back pain improvement was curvilinear, with the majority of improvement occurring in the first two weeks after seeking care, and a leveling off of improvement after 4 weeks. However, despite the fact that pain levels were constantly changing during acute LBP, individuals were able to identify pain flares that corresponded to statistically significant increases in pain intensity as compared to other individuals not reporting flares, with a flare 'effect' of almost 3 points on the NPRS at any time during follow-up. This flare effect exceeds the threshold of 2 NPRS points commonly accepted as a minimal important change in NPRS[20]. The high degree of variability typical during acute LBP is difficult to accurately conceptualize using descriptions of flare frequency and magnitude of common pain intensity changes; Figures 3 and 4 present two examples of individual patient data that better convey the degree of variability seen during acute LBP.

Bottom Line: A model with a quadratic trend for time best characterized improvements in pain.Pain decreased rapidly during the first 14 days after seeking care, and leveled off after about 28 days.Acute LBP is characterized by variability.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of PM&R, VA Boston Healthcare System, Boston, USA. pradeep.suri@va.gov

ABSTRACT

Background: Pain variability in acute LBP has received limited study. The objectives of this pilot study were to characterize fluctuations in pain during acute LBP, to determine whether self-reported 'flares' of pain represent discrete periods of increased pain intensity, and to examine whether the frequency of flares was associated with back-related disability outcomes.

Methods: We conducted a cohort study of acute LBP patients utilizing frequent serial assessments and Internet-based data collection. Adults with acute LBP (lasting ≤3 months) completed questionnaires at the time of seeking care, and at both 3-day and 1-week intervals, for 6 weeks. Back pain was measured using a numerical pain rating scale (NPRS), and disability was measured using the Oswestry Disability Index (ODI). A pain flare was defined as 'a period of increased pain lasting at least 2 hours, when your pain intensity is distinctly worse than it has been recently'. We used mixed-effects linear regression to model longitudinal changes in pain intensity, and multivariate linear regression to model associations between flare frequency and disability outcomes.

Results: 42 of 47 participants (89%) reported pain flares, and the average number of discrete flare periods per patient was 3.5 over 6 weeks of follow-up. More than half of flares were less than 4 hours in duration, and about 75% of flares were less than one day in duration. A model with a quadratic trend for time best characterized improvements in pain. Pain decreased rapidly during the first 14 days after seeking care, and leveled off after about 28 days. Patients who reported a pain flare experienced an almost 3-point greater current NPRS than those not reporting a flare (mean difference [SD] 2.70 [0.11]; p < 0.0001). Higher flare frequency was independently associated with a higher final ODI score (ß [SE} 0.28 (0.08); p = 0.002).

Conclusions: Acute LBP is characterized by variability. Patients with acute LBP report multiple distinct flares of pain, which correspond to discrete increases in pain intensity. A higher flare frequency is associated with worse disability outcomes.

Show MeSH
Related in: MedlinePlus