There is a commonly held clinical belief that 90% of all low back pain episodes spontaneously self-resolve within a 60 day period.
It would appear that this commonly held “fact” may not be “factual” at all.
Possibly the most authoritative textbook of the 1970’s “Clinical Biomechanics of the Spine” was the main contributor to the 60 day self healing belief. An important comment was made on page 424 of the book.
“There are few diseases [low back pain] in which one is assured improvement of 70% of the patients 3 weeks and 90% of the patients in two months, regardless of the type of treatment employed.”
Firstly we need to ask where is this statement derived?
Reference J Dixon; Progress and Problems in Back Pain Research; Rheumatology and Rehabilitation; Volume 12, Number 4; November 1973; Pages 165-175.
Surprisingly the reference is not a scientific study at all. The reference is actually from a paper read at the Annual Meeting of the British Association for Rheumatology and Rehabilitation, London, March 1973.” (p. 165)
The first two sentences of the article are as follows:
“It is a great honor to be invited to talk to my own Medical School, but I am not noted for my contribution to back pain research nor for my startling observations into the biochemistry of the human intervertebral disc. My only contribution has been to show that patients with non-specific back pain more often do better in a rabbit-wool body belt than in a rigid spinal corset which they are more frequently prescribed.” (p. 165)
It is quite obvious, from Dixon’s own opening statement, he is not an expert on back pain, nor is he a back pain researcher of any kind.
Even though Dr. Dixon is the most often end reference of the natural history of back pain, a review of Dixon’s article finds that he actually quotes another article as well J Fry; Advisory Services Colloquia; “Back Pain and Soft Tissue Rheumatism”; Advisory Services (Clinical & General) Ltd., London; Number 1; 1972; Page 8
Dr. Fry’s contribution to the colloquium includes the following:
In an average GP practice each year 125 patients could be expected for soft tissue rheumatism or acute back pain.
“Of these 125 patients, 50 would be likely to be suffering from acute back pain and 25 from acute neck pain.”
“44% of the patients with acute low back pain lost their symptoms in less than one week and 82% in less than 4 weeks.”
Dr. Fry makes it abundantly clear that these numbers are from a retrospective review of his general practitioner practice of acute low back pain patients.
Dr. Fry provides no information regarding how he evaluated his patients and their progress or lack there of. Equally he fails to discuss how many patients he used to establish these statistics.
A more recent group of researchers, led by professor Peter Croft published in the British Medical Journal, actually took the time to evaluate the statistics on the natural history of low back pain that are frequently attributed to Dixon, and they unequivocally show Dixon’s statistics to be false.
Here is the review of the Croft Group article, the results speaks for themselves:
“Outcome of low back pain in general practice: a prospective study; British Medical Journal; May 2, 1998; Vol. 316, pp. 1356-1359; Peter R Croft, Gary J Macfarlane, Ann C Papageorgiou, Elaine Thomas, Alan J Silman”
KEY MESSAGES FROM AUTHORS:
1) It is widely believed that 90% of episodes of low back pain seen in general practice resolve within one month.
2) While 90% of subjects consulting the GP pactice with low back pain ceased to consult about the symptoms within three months, most still had substantial low back pain and related disability.
3) Only 25% of the patients who consulted about low back pain had fully recovered 12 months later.
KEY POINTS FROM THIS ARTICLE INCLUDE:
1)This prospective study of 463 patients with an acute episode of low back pain agrees with numerous other studies that indicate that approximately 90% of such patients will stop consulting their doctor about their back within three months. In this study the number was actually 92%.
2)However, this study is adamant that NOT seeing a doctor for a back problem does NOT mean that the back problem has resolved. This study showed that 75% of the patients with a new episode of low back pain have continued pain and disability a year later, even though most are not continuing to go to the doctor.
3)The belief that “90% of episodes of low back pain seen in general practice resolve within one month” is false, and based primarily upon one flawed study published in 1973 by Dixon. [As noted above, Dixon is NOT a study, and should not be referred to as such.]
4)It is generally believed that most low back pain episodes will be “short lived and that ’80-90% of attacks of low back pain recover in about six weeks, irrespective of the administration or type of treatment.'” This belief is untrue, false.
5)Many patients seeing their general practitioner for the first time with an episode of back pain will still have pain or disability 12 months later but not be consulting their doctor about it. [Very Important]
6)Low back pain should be viewed as a chronic problem with an untidy pattern of grumbling symptoms and periods of relative freedom from pain and disability interspersed with acute episodes, exacerbations, and recurrences.
7)90% of episodes of low back pain DO NOT end in complete recovery within a few months.
If you are part of the 92% with back pain that hasn't got better by itself, please contact our Belfast clinic to see if Chiropractic can help you.