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Pain Med. 2019 Mar 19. pii: pnz021. doi: 10.1093/pm/pnz021. [Epub ahead of print]

What Triggers an LBP Flare? A Content Analysis of Individuals' Perspectives.

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School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
Institute of Bone and Joint Research/The Kolling Institute, Sydney Medical School, The University of Sydney, Sydney, Australia.



For many, low back pain (LBP) is a lifelong condition with symptoms varying over time. Previous studies have investigated long-term risk factors and triggers for onset of LBP. No study has examined causes for less distinct fluctuations of symptoms, such as "flares," which individuals with LBP identify as a significant and worrisome part of LBP. As little is known about what triggers this type of fluctuation, we aimed to investigate individuals' perspectives on LBP flare triggers.


We conducted an online survey of 130 people with LBP, asking what they think triggers their flares. Data were qualitatively examined using content analysis.


Most participants identified biomedical (84.8%) triggers, endorsing physical/biological factors to explain the flare occurrence. Themes included active movements (35% of participants), static postures (28.1%), overdoing a task (5.3%), biomechanical dysfunction (4.4%), comorbidities (4%), lack of exercise (3.3%), work (1.8%), and medications (1.5%). Nonbiomedical triggers were reported by 15.2% and included psychosocial and contextual factors, including psychological state (6%), weather (5%), sleep (2%), diet (1.2%), and fatigue (1%). These results indicate that individuals consider biomedical factors to be the main triggers of LBP flares, but some acknowledge nonbiomedical triggers.


Study findings contrast with current pain theories, which suggest that there is a need for a reduced emphasis on biomedical causes of LBP pain, especially when persistent. Recognition of patients' views on causes of LBP flares is crucial to better guide clinical practice and inform further research. The validity of triggers identified by LBP patients requires further investigation.


Content Analysis; Flare; Low Back Pain; Triggers


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