Prognosis of mechanical low back pain
What is the prognosis of patients with mechanical low back pain?
It is estimated that up to 80% of all individuals will develop back pain during their life. Despite the potential number of people affected, the overall prognosis is good. Within 1 week of an acute episode, 50% of patients have symptomatic improvement; 75% will improve after 1 month; and 87% improve at 3 months. By 6 months, 93% are better. However, ≥25% patients have recurrent pain within the next year, and chronic low back pain develops in up to 7% to 10% of patients. Poor prognosis has been associated with the requirement for narcotics as well as receipt of disability benefits and/or workmen’s compensation. Failure to return to employment within several months following an injury at work is associated with a poor outcome as well. Among patients with chronic low back pain, a subset will lack a clear anatomic driver of pain (nonspecific low back pain), whereas others may exhibit a component of a centralized pain syndrome similar to fibromyalgia. In addition, high rates of depression have been identified among patients who go on to develop chronic low back pain. Clinicians should thus assess for depression and additional psychosocial factors at baseline that may predict (and contribute) to the development and perpetuation of chronic pain.