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Chiropr Man Therap. 2018 Jan 9;26:1. doi: 10.1186/s12998-017-0172-9. eCollection 2018.

Failure to define low back pain as a disease or an episode renders research on causality unsuitable: results of a systematic review.

Author information

1
School of Health Professions, Murdoch University, 90 South St, Murdoch, WA 6150 Australia.
2
Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark.

Abstract

Background:

Causative factors may be different for the very first onset of symptoms of the 'disease' of low back pain (LBP) than for ensuing episodes that occur after a pain-free period. This differentiation hinges on a life-time absence of low back pain at first onset and short-term absence for further episodes. In this systematic review, we explored whether researchers make these distinctions when investigating the causality of LBP.

Methods:

A literature search of PUBMED, CINAHL, and SCOPUS databases was performed from January 2010 until September 2016 using the search terms 'low back pain' or 'back pain' and 'risk factor' or 'caus*' or 'predict*' or 'onset' or 'first-time' or 'inception' or 'incidence'. Two reviewers extracted information on study design, types of episodes of back pain to distinguish the disease of LBP and recurring episodes, and also to determine the definitions of disease- or pain-free periods.

Results:

Thirty-three articles purporting to study causes of LBP were included. Upon scrutiny, 31 of the 33 articles were unclear as to what type of causality they were studying, that of the 'disease' or the episode, or a mere association with LBP. Only 9 studies used a prospective study design. Five studies appeared to investigate the onset of the disease of LBP, however, only one study truly captured the first incidence of LBP, which was the result of sports injury. Six appeared to study episodes but only one clearly related to the concept of episodes. Therefore, among those 11 studies, nine included both first-time LBP and episodes of LBP. Consequently, 22 studies related to the prevalence of LBP, as they probably included a mixture of first-time, recurring and ongoing episodes without distinction.

Conclusion:

Recent literature concerning the causality of LBP does not differentiate between the 'disease' of LBP and its recurring episodes mainly due to a lack of a clear definition of absence of LBP at baseline. Therefore, current research is not capable of providing a valid answer on this topic.

KEYWORDS:

Cause; Incidence; Low back pain; Methodology; Onset; Risk factor; Systematic review

PMID:
29321845
PMCID:
PMC5759306
DOI:
10.1186/s12998-017-0172-9
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Not applicable.Not applicable.Associate Professor Bruce Walker AM is the Editor-in-Chief of Chiropractic & Manual Therapies and Professor Charlotte Leboeuf-Yde is Senior Editorial Advisor to the same journal. Both were blinded to review and played no part in the editorial management of this submission.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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