Review Question - QID 3717

Most adults (up to 80%) will experience an episode of low back pain in their lifetime. In those whose pain is severe enough to cause them to miss work, 60 to 70% will return by 6 weeks, and 80 to 90% will return by 12 weeks.

Low back pain is common in adults. Most patients experience resolution of symptoms quickly and have no lasting loss of function. However, 5 to 10% develop chronic pain. Recurrence of pain is common, and is part of the natural history, occurring in 20 to 72% of patients. After 12 weeks, return to work rates are slow.

Shen et al. review the nonoperative management of acute and chronic low back pain. The authors note that none of the available interventions has been proven by high quality large randomized controlled trials. The authors believe that low dose oral steroids are safe in the short term and that injection therapy should not be used without a reasonable presumptive diagnosis.

Madigan et al. review the management of lumbar degenerative disease. The authors emphasize that the majority of patients improve within 6 weeks with or without treatment. For patients that do not, the authors do not recommend epidural injection, as there are no good studies to support their use in the treatment of discogenic back pain. When surgical treatment is indicated they state that arthrodesis is the gold standard, although the long term results of total disk arthroplasty are being elucidated.

Illustration A shows a table of available non-operative treatment modalities for back pain. Illustration B shows a list of possible diagnoses associated with acute low back pain, with those associated with neurogenic pain italicized. Illustration C shows a list of 'red flag' symptoms indicating serious/emergent causes of low back pain.

Incorrect answers:
Answer 1: 80 to 90% will return by 12 weeks.
Answer 2: Longer than 6 weeks is required for 80% return
Answers 4, 5: These numbers are too low for return to work at 6 weeks.