DETERMINATION OF THE NATURAL COURSE OF ACUTE AND SUBACUTE
LOW BACK PAIN
Title.
The natural course of acute and subacute
low back pain.
Background.
Most of the studies on low back pain have
been made at Health Centers or hospitals, so that all the
patients have received treatment. Thus, for example, the efficacy
of different treatments has been compared (in studies in which
all the patients have been treated, though different treatments
may have been applied to the different groups) or the evolution
of the series of patients who have been treated in one way
or another has been described.
The problem is that very few studies have been focused on
what the natural course of back pain might be, if left to
its free evolution without treatment. Knowing through reliable
information about the "natural tendency" of the
illness would be very useful, among other objectives, as baseline
information to serves as reference when evaluating new treatments
or diagnostic strategies.
A study of this nature has an obvious ethical limitation;
it is unacceptable to voluntarily deprive a patient who needs
it of a treatment shown to be effective. For that reason,
the study must be limited to patients in whom, for the special
characteristics of their case, do not require treatment, reject
it or to whom the treatment cannot be administered. Furthermore,
this limitation is maintained throughout the evolutionary
course of the illness, so that if at any moment the patient
requires treatment -and it is also possible to administer
it and the patient accepts it-the treatment must be given.
Clearly, the information coming from a specific group of
patients that, because of their special characteristics, can
remain some time without treatment, cannot be immediately
and directly extrapolated to the group of patients with back
pain, since they may not be representative. For that reason,
it is especially important to gather all the necessary information
to define their peculiarities.
Objective.
To describe the natural course of low back
pain in patients who do not receive treatment.
Design
Prospective cohort study.
Methodology.
The study was made with a convenience sample
of 692 patients who consulted their primary care physician
for low back pain with or without radiated pain, and of whom
407 were not receiving treatment on their first visit.
The patients were followed for 6 months, and their clinical
situation was evaluated the first day they requested care,
and at 15, 60 and 180 days. On each occasion, all the relevant
clinical information was gathered (including among other aspects
the existence of signs that made one suspect the presence
of a serious illness, signs of neurological compromise, and
pain intensity and degree of disability), as well as diagnostic
tests and prescribed treatments.
In the analysis phase, it was determined how many of the
patients had not received treatment at any moment of the study,
establishing the factors that explained that fact and studying
their clinical evolution.
Participants, along with the Foundation's
Science Department.
106 researchers from 40 Primary Care centers
and Primary Care Research Units in Badajoz, Baleares, Bilbao,
Burgos, Cáceres, Cuenca, Guadalajara, Huesca, Madrid,
Murcia, Palencia, Valencia, as well as the Unit of Clinical
Biostatistics at the Hospital Ramón y Cajal, Madrid;
all of them part of the Spanish Network of Researchers in
Back Disorders.
The study was funded in full by the Kovacs Foundation.
Status.
Data collection has been completed and data
is currently being analyzed.
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