Clinical Update: Low Back Pain Becomes Chronic More Often Than Previously Thought

By Dr. David I . Graber

One-third of people with acute low back pain becomes chronic according to a new study out this week in JAMA. Previous recommendations and clinical guidelines have stated the natural course of most episodes of low back pain (LBP) to be a self-limiting condition lasting 30-90 days. The current study by Stevens, et al. questions this.

Among their findings is that the overall transition to chronic LBP was 32%. These results indicate that the transition from acute to chronic LBP is much greater than historically appreciated. Chronic low back pain is more difficult to treat and is more costly to manage.

They further found that approximately 60% of the patients who developed chronic LBP at six months were in the low-risk and medium-risk groups. The severity of an episode of back pain and the risk factors present isn’t very predictive of it becoming chronic.

Several factors were associated with increased odds of developing chronic LBP. These were:

  • Higher baseline disability as assessed by the Oswestry Disability Index
  • Having health insurance (e.g., Medicaid)
  • Higher body mass index (e.g., obesity)
  • Smoking
  • Having back and leg pain
  • Psychological co-morbidities (e.g., diagnosed depression/anxiety)
  • Non-concordant care – care that does not follow clinical guidelines  

This study adds support to the clinical philosophy of treating and managing patients with low back pain episodes, rather than letting the condition “heal on its own.”

Stevans JM, Delitto A, Khoja SS, et al. Risk Factors Associated With Transition From Acute to Chronic Low Back Pain in US Patients Seeking Primary Care. JAMA Netw Open. 2021;4(2):e2037371. doi:10.1001/jamanetworkopen.2020.37371

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