Back pain is the primary cause of disability in people <50 years of age. The annual incidence in the adult population is 10% to 15% with a point prevalence of approximately 30% in developed countries. Low-back pain (LBP) is second only to upper respiratory problems for physician visits each year, with a lifetime prevalence of 70% to 85%. Despite its widespread prevalence, the general prognosis of acute LBP is favorable, as 90% of patients recover without sequelae.[1]Spitzer WO, LeBlanc FE, Dupuis M, et al. Scientific approach to the assessment and management of activity-related spinal disorders: a monograph for clinicians. Report of the Quebec Task Force on Spinal Disorders. Spine. 1987 Sep;12(7 Suppl):S1-59.
http://www.ncbi.nlm.nih.gov/pubmed/2961086?tool=bestpractice.com
Recurrences are common, but most relapses are not disabling. A smaller subset of the population may be incapacitated from chronic LBP, defined as symptoms persistent for >6 months. Depression, job dissatisfaction, and medicolegal issues involving financial compensation predispose a patient to suffer long term.[2]Bigos SJ, Battie MC, Spengler DM, et al. A prospective study of work perceptions and psychosocial factors affecting the report of back injury. Spine. 1991 Jan;16(1):1-6.
http://www.ncbi.nlm.nih.gov/pubmed/1825891?tool=bestpractice.com
[3]Burton AK, Tillotson KM, Main CJ, et al. Psychosocial predictors of outcome in acute and subacute low back trouble. Spine. 1995 Mar 15;20(6):722-8.
http://www.ncbi.nlm.nih.gov/pubmed/7604349?tool=bestpractice.com
[4]Carragee EJ, Alamin TF, Miller JL, et al. Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain. Spine J. 2005 Jan-Feb;5(1):24-35.
http://www.ncbi.nlm.nih.gov/pubmed/15653082?tool=bestpractice.com
[5]Boos N, Semmer N, Elfering A, et al. Natural history of individuals with asymptomatic disc abnormalities in magnetic resonance imaging: predictors of low back pain-related medical consultation and work incapacity. Spine. 2000 Jun 15;25(12):1484-92.
http://www.ncbi.nlm.nih.gov/pubmed/10851096?tool=bestpractice.com
Several studies have demonstrated that the longer a patient is absent from work, the less likely he or she will return to work.[6]Bergquist-Ullman M, Larsson U. Acute low back pain in industry. A controlled prospective study with special reference to therapy and confounding factors. Acta Orthop Scand. 1977;(170):1-117.
http://www.ncbi.nlm.nih.gov/pubmed/146394?tool=bestpractice.com
Furthermore, a small percentage of patients will develop persistent disabling LBP resulting in immense costs to society. Estimates approach $50 billion per year in the US.[7]Cypress BK. Characteristics of physician visits for back symptoms: a national perspective. Am J Public Health. 1983 Apr;73(4):389-95.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1650784/pdf/amjph00639-0037.pdf
http://www.ncbi.nlm.nih.gov/pubmed/6219588?tool=bestpractice.com
[8]Coste J, Delecoeuillerie G, Cohen de Lara A, et al. Clinical course and prognostic factors in acute low back pain: an inception cohort study in primary care practice. BMJ. 1994 Feb 26;308(6928):577-80.
http://www.bmj.com/cgi/content/full/308/6928/577
http://www.ncbi.nlm.nih.gov/pubmed/8148683?tool=bestpractice.com
[9]Waddell G. Low back pain: a twentieth century health care enigma. Spine. 1996 Dec 15;21(24):2820-5.
http://www.ncbi.nlm.nih.gov/pubmed/9112705?tool=bestpractice.com
[10]Pauza KJ, Howell S, Dreyfuss P, et al. A randomized, placebo-controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain. Spine J. 2004 Jan-Feb;4(1):27-35.
http://www.ncbi.nlm.nih.gov/pubmed/14749191?tool=bestpractice.com
Several factors have been found to increase the risk of developing disabling LBP. These include maladaptive pain coping behaviors, nonorganic signs, functional impairment, poor general health status, and psychiatric comorbidities.[11]Chou R, Shekelle P. Will this patient develop persistent disabling low back pain? JAMA. 2010 Apr 7;303(13):1295-302.
http://www.ncbi.nlm.nih.gov/pubmed/20371789?tool=bestpractice.com
The clinician should be aware of these risk factors when counseling and treating patients.
