Prevalence of Pain-free Weeks in Chiropractic Subjects With Low Back Pain – A Longitudinal Study Using Data Gathered With Text Messages
SOURCE: Chiropractic & Manual Therapies 2011 (Dec 14); 19: 28 ~ FULL TEXT
Nadège Lemeunier, Alice Kongsted, and Iben Axén
Institut Franco-Européen de Chiropratique,
INTRODUCTION: The use of automated text messages has made it possible to identify different courses of low back pain (LBP), and it has been observed that pain often fluctuates and that absolute recovery is rather rare. The purpose of this study was to describe the prevalence of pain-free weeks and pain-free periods in subjects with non-specific LBP treated by chiropractors, and to compare subjects from two different countries in these aspects.
METHODS: Data were obtained from two practice-based multicentre prospective outcome studies, one Danish and one Swedish, involving subjects being treated by chiropractors for non-specific LBP. Over 18 weeks, subjects answered a weekly automated text message question on the number of days in the past week that they had experienced bothersome LBP, i.e. a number between 0 and 7. The number of weeks in a row without any LBP at all (“zero weeks”) as well as the maximum number of zero weeks in a row was determined for each individual. Comparisons were made between the two study samples. Estimates are presented as percentages with 95% confidence intervals.
RESULTS: In the Danish and the Swedish populations respectively, 93/110 (85%) and 233/262 (89%) of the subjects were eligible for analysis. In both groups, zero weeks were rather rare and were most commonly (in 40% of the zero weeks) reported as a single isolated week. The prevalence of pain free periods, i.e. reporting a maximum of 0, 1 or 2, or 3-6 zero weeks in a row, were similar in the two populations (20-31%). Smaller percentages were reported for ≥ 7 zero weeks in a row. There were no significant differences between the two study groups.
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CONCLUSION: It was uncommon that chiropractic subjects treated for non-specific LBP experienced an entire week without any LBP at all over 18 weeks. When this occurred, it was most commonly reported for brief periods only. Hence, recovery in the sense that patients become absolutely pain free is rare, even in a primary care population.
From the FULL TEXT Article:
Low back pain (LBP) is a very common condition with an annual prevalence of at least 50%.  However, approximately 80% of patients suffering from LBP are diagnosed with non-specific LBP  because the specific causes are rather rare. One consequence is that it is difficult to find an effective treatment for this large, heterogeneous group of patients, which probably explains the limited treatment effect generally obtained in scientific trials. [3, 4]
Traditionally, randomized clinical trials and outcome studies have the disadvantage of measuring outcome at only a few points in time, leaving an absence of data for the periods in between. However, for patients the time “in between” is as important as some arbitrarily selected points in time, such as at 6 or 12 months after treatment. Further, LBP often runs an episodic or fluctuating course [5-8] which is ignored by follow ups measured only at one or a few points in time. Commonly, the proportion of subjects who are improved at these time points is estimated. This approach fails to take the trajectory of pain into account, thereby not fully describing recovery or improvement. With the use of diaries or automated text messages it is possible to follow the course of a disease more closely, whether treated or not.