Outcome of low back pain in general practice: a prospective study

BMJ 1998;316:1356-1359 ( 2 May )

General Practice

Outcome of low back pain in general practice: a prospective study

Peter R Croft, professor, ^a Gary J Macfarlane, senior lecturer, ^b Ann C Papageorgiou, studies coordinator, ^b Elaine Thomas, research statistician, ^b Alan J Silman, director. ^b

^a University of Keele, School of Postgraduate Medicine, Industrial and Community Health Research Centre, Hartshill, Stoke on Trent ST4 7QB, ^b ARC Epidemiology Research Unit, School of Epidemiology and Health Sciences, University of Manchester, Stopford Building, Manchester M13 9PT

Correspondence to: Dr Macfarlane G.Macfarlane{at}man.ac.uk

Objectives: To investigate the claim that 90% of episodes of low back pain that present to general practice have resolvedwithin one month.
Design: Prospective study of all adults consulting in general practice because of low back pain over 12 months withfollow up at 1 week, 3 months, and 12 months after consultation.
Setting: Two general practices in south Manchester.
Subjects: 490 subjects (203 men, 287 women) aged 18-75 years.
Main outcome measures: Proportion of patients who have ceased to consult with low back pain after 3 months; proportionof patients who are free of pain and back related disability at3 and 12 months.
Results: Annual cumulative consultation rate among adults in the practices was 6.4%. Of the 463 patients who consultedwith a new episode of low back pain, 275 (59%) had only a singleconsultation, and 150 (32%) had repeat consultations confinedto the 3 months after initial consultation. However, of thoseinterviewed at 3 and 12 months follow up, only 39/188 (21%) and42/170 (25%) respectively had completely recovered in terms ofpain and disability.
Conclusions: The results are consistent with the interpretation that 90% of patients with low back pain in primarycare will have stopped consulting with symptoms within three months.However most will still be experiencing low back pain and relateddisability one year after consultation.

Key messages

It is widely believed that 90% of episodes of low back pain seen in general practice resolve within one month
In a large population based study we examined the outcome of episodes of low back pain in general practice with respect to both consultation behaviour and self reported pain and disability
While 90% of subjects consulting general practice with low back pain ceased to consult about the symptoms within three months, most still had substantial low back pain and related disability
Only 25% of the patients who consulted about low back pain had fully recovered 12 months later
Since most consulters continue to have long term low back pain and disability, effective early treatment could reduce the burden of these symptoms and their social, economic, and medical impact

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Serious disease and secondary gain.: George J Addis
bmj.com, 3 May 1998 [Full text]
Non attendance and morbidity from low back pain.: Alastair Hay
bmj.com, 12 May 1998 [Full text]
Evidence based, beneficial and cost effective care for back pain is available.: Jeffrey M Shurr
bmj.com, 10 Jun 1998 [Full text]
Kudos for your research: Bruce J Haggart
bmj.com, 6 Apr 1999 [Full text]
Re: Evidence based, beneficial and cost effective care for back pain is available.: Steve Lockhart
bmj.com, 1 May 1999 [Full text]
Workers' Compensation Costs Lowered by Making Back Exercises Mandatory: Gregory T Wright
bmj.com, 18 Jun 1999 [Full text]
Re: Re: Evidence based, beneficial and cost effective care for back pain is available.: Frank Conijn
bmj.com, 6 Oct 1999 [Full text]
Re: Non attendance and morbidity from low back pain.: Susan Smithson
bmj.com, 24 Feb 2001 [Full text]