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From the Sufferers: Discussion on low back pain recurrences.

Despite the focus given to the condition, a proper measurement system is still lacking

Low back pain (LBP) remains one of the most burdensome and prevalent medical conditions in existence, a fact exacerbated by its complicated nature and tendency to reoccur. Studies claim that anywhere from 24-87% of sufferers have subsequent back pains within a year, and many deal with the condition on an ongoing basis, accounting for elevated health-care costs related to workers' compensation and time off work. Due to these factors, LBP recurrence has received an increase in research attention, but a proper, consistent way to measure and conceptualize it has not yet been established. Most recurrence measures focus on repeated episodes of pain, disability, health-care utilization and time off work, but some feel these measures do not paint a complete picture. A better understanding of LBP recurrence is necessary to help health-care professionals create effective treatment protocols. To address this, a qualitative investigation was conducted focusing on individuals with a history of LBP and how it affects their lives.

Focus groups promoting discussion used to gather data

The study design used focus groups for LBP sufferers to collect information. Ads were posted in a newspaper and 31 people participated in six focus groups, which were led by researchers who would ask questions and share opinions to stimulate conversation. All discussions were recorded, and then analyzed for meaningful trends on LBP.

Trends of recurrent LBP: a continuous condition that's always felt to some degree

Overall, participants expressed a general sentiment that the pain was the same as it had been in the past, and most failed to define recurrence episodes, but rather saw it as a condition that was always there. From these descriptions of the pain being "always there," four themes arose: 1) accommodated lifestyle, 2) anxiety and stigmatization, 3) impact on relationships and 4) fluctuating pain levels and types. The extent to which LBP affected participants was extreme in most cases, often preventing them from doing normal things in their everyday lives. Pain was categorized as either "normal," "flared-up," and "attack," the most intense bouts of pain that leave some unable to move. Analysis of work participation and health care usage showed that many would only take off work as a last resort since they couldn't afford it, and most claimed that the health-care system did not provide them with any benefit since some physicians don't understand the condition. It was therefore determined that LBP recurrence measurements based on time off or health-care usage is inaccurate and inconsistent. Instead, LBP should be viewed as a complex and multidimensional health condition, and considerations must be made to the patient's personal history, coping style, participation aspirations and environmental resources, as well as the frequency and severity of pain, in order to best understand it and improve available treatments and outcomes.

-As reported in the Dec. '10 edition of Pain

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