| Description |
Low back (LBP) pain is common and represents a significant societal burden due to costs associated with lost work productivity and medical care. LBP presenting with leg pain, or lumbosacral radicular syndrome (LRS), worsens prognosis and increases disability and cost. Recovery from LBP is highly variable. Improving our understanding of recovery after acute LBP provides an opportunity to change the course of symptoms. Recent studies have identified distinct recovery patterns among patients with LBP. These are generally represented by recovery, moderate persisting pain, high persisting pain, or recurrence. In a cohort of workers with incident LBP, we examined the presence of these patterns. Using pain scores from monthly follow-up visits over the course of 1 year, we characterized recovery. A growth mixture model identified four distinct trajectories consistent with previous literature with distributions favoring recovery. The four classes were identified as recovered (60%), moderate persisting pain (28%), high persisting pain (8%) and recurrent pain (4%). The presence of leg pain increased pain intensity, slowed recovery, and increased the likelihood of being in the high persisting pain class. We further characterized these classes by examining the association between baseline covariates and class status using logistic regression. Moderate persisting pain and high persisting pain was more prevalent among Hispanic workers and those reporting more severe prior low back pain. Additionally, high lifting demands and low social iv support from coworkers was associated with moderate persisting pain. Workers with LRS were twice as likely to have high persisting pain even after adjusting for race and low back pain history (adjusted OR 2.7 (1.4, 5.4)). Finally, in a nationally representative cohort from the SPORT population, we examined nonsurgical treatments utilized in managing patients with persisting symptoms of LRS who seek secondary care but do not elect surgical management. The primary nonsurgical interventions used were medication, spinal injections, and physical therapy. Higher baseline disability, the presence of neurologic deficit, and patient preference for physical therapy were all factors associated with receiving physical therapy as an initial management strategy. Patients receiving physical therapy within the first 6 weeks did not demonstrate any significant differences in primary outcomes of pain and disability compared to those who did not receive physical therapy. Recovery from LBP is highly variable but seems to be described by four distinct patterns of pain. Individuals with low back-related leg pain (LRS) have increased odds of a poor recovery. For patients with persistent LRS, there is significant variation and complexity in nonsurgical management decisions without clear benefit in clinical outcomes. There remains a need to identify optimal management strategies and sequencing of treatment for this population. |
