Back pain recovery is slow

Contrary to current guidelines and common belief, new research has shown that recovery from low back pain is much slower than previously thought and even slower again for those with a compensable injury.

The findings of the first study of its kind in Australia were released today by Australian researchers at The George Institute for International Health.

The study, published in The British Medical Journal, showed that nearly one third of patients did not recover from the original episode of back pain within a year.

The authors concluded that prognosis from acute (or recent) lower back pain is not as favourable as claimed in clinical practice guidelines and challenges the common belief that 90 per cent of patients recover within four to six weeks, with or without treatment.

“These are extremely important results because they confirm that low back pain is a significant health problem and that there is substantial room for improvement in its management,” said author Professor Chris Maher, The George Institute, Australia.

Researchers studied 973 patients with acute low back pain for one year.

Each was managed by their preferred clinician; a doctor, physiotherapist or chiropractor, who followed treatment guidelines established by Australia’s National Health and Medical Research Council (NHMRC).

It is estimated that approximately 20 per cent of the Australian population suffers from low back pain at any one time.

The findings show that even with treatment, after two months only 50 per cent had fully recovered from the original episode of pain. At one year about 40 per cent reported that their back was still causing them pain.

“These results challenge the accepted view that recovery is rapid following an episode of acute low back pain. For many people back pain becomes a long-term problem that severely impacts their life. This is despite receiving what we think is the best possible care. We clearly need to rethink our approach,” Professor Maher added.

The strongest predictor of delayed recovery was if the episode of low back pain was compensable: compensation halved the chances of recovery.

“The results also suggest we should review our compensation system because people within this system do much worse than those outside of it. More work needs to be done as this is an extremely complex system.”

Low back pain is the most prevalent and costly musculoskeletal condition in Australia, estimated to cost up to $1billion per annum with indirect costs exceeding $8billion.

(Source: The British Medical Journal: George Institute for International Health: July 2008)