October 8, 2009 — 根據線上發表於10月6日英國醫學期刊(British Medical Journal)的一篇創始世代研究結果，無併發症的慢性下背痛病患，約有40%在一年內恢復。
澳洲雪梨大學、喬治國際健康研究中心博士候選人Luciola da Cunha Menezes Costa與其研究夥伴寫道，慢性下背痛的預後不確定。雖然臨床指引一般將此狀況描寫為預後不佳，但可能依據的是不具代表性的存活世代研究、或者大部份未加以追蹤的研究。有關慢性下背痛的預後研究，獲得有代表性的世代是研究設計時最主要的問題。
More Than One Third of Patients With Chronic Low Back Pain Recover Within 1 Year
By Laurie Barclay, MD
Medscape Medical News
October 8, 2009 — About 40% of patients with uncomplicated chronic low back pain recover within 1 year, according to the results of an inception cohort study published online October 6 in the British Medical Journal.
"The prognosis of chronic low back pain is uncertain," write Luciola da Cunha Menezes Costa, PhD candidate from George Institute for International Health, University of Sydney in Australia, and colleagues. "Although clinical guidelines generally portray the condition as having a poor prognosis this is based either on studies of potentially unrepresentative survival cohorts or on studies with large losses to follow-up. Obtaining a representative cohort is the major problem in designing valid studies on the prognosis of chronic low back pain."
The goal of this study was to assess the course of chronic low back pain in an inception cohort and to identify prognostic markers at the onset of chronicity, using a subcohort of an inception cohort of 973 consecutive patients seen at primary care clinics in Sydney, Australia, with acute low back pain starting less than 2 weeks previously. The inception cohort of patients with chronic low back pain consisted of 406 participants with back pain persisting for 3 months.
Outcome measures and potential predictors of chronicity were evaluated when the patients were first seen, at study entry, and at 9- and 12-month follow-up. Assessment of pain intensity, disability, and work status allowed determination of recovery. Cox regression modeling helped evaluate the association between potential prognostic markers and time to recovery.
For all outcomes, completeness of follow-up was 97% of total person time. At 9 months, the cumulative probability of being pain-free was 35% and increased to 42% at 12 months. For complete recovery, the percentages were 35% and 41%, respectively. At entry to the chronic study, 259 participants had not recovered from pain-related disability, but 47% of these had recovered by 12 months.
Factors associated with delayed recovery were previous sick leave for low back pain, high levels of disability or pain intensity at onset of chronicity, low educational levels, higher perceived risk for persistent pain, and birthplace outside Australia.
Limitations of this study include inability to measure prognostic outcomes blinded and self- reporting of prognostic markers.
In an accompanying editorial, Elaine M. Hay, MD, and Kate M. Dunn, PhD, from the Arthritis Research Campaign National Primary Care Centre of Keele University in Staffordshire, United Kingdom, note that much longer follow-up is needed to determine the true prognosis of chronic low back pain.
"The authors have shown that even within the highly selected group of patients with chronic back pain included in their inception cohort, non-specific back pain is a heterogeneous condition," Dr. Hay and Dr. Dunn write. "Some patients recover over the course of a year, but most do not, and the likelihood of persistence is influenced by certain (prognostic) factors identified at the point of consultation. The challenge remains for researchers to translate these findings into novel intervention studies that tackle what patients want to know — given my symptoms, which treatment will work best for me now, and in the future?"
The National Health and Medical Research Council of Australia supported this study and some of its authors. The study authors and editorialists have disclosed no relevant financial relationships.
