Poor outcomes for back patients revealed

One-third unsatisfied seven weeks after visit

More back pain patients may be unhappy with their outcomes seven weeks or even a year after their treatment than many primary care physicians think, according to a study published in the journal Spine that used a patient-focused quality-of-life measure.1

Patients responded on a scale from "delighted" to "terrible" to the question, "If you were to spend the rest of your life with your back or leg symptoms just the way they have been in the last 24 hours, how would you feel?"

One-third of patients responded with "mixed" feelings or worse seven weeks after treatment, and 29% of patients still had negative feelings a year after treatment. All 219 patients in the randomized trial had made a first visit to a primary care clinic for a current episode of low back pain.

Based on other studies that show improvement in symptoms for some 90% of back pain patients after three weeks,2 primary care physicians may have an overly optimistic view about probable outcomes, cautions lead author Daniel Cherkin, PhD, senior scientific investigator with the Center for Health Studies at Group Health Cooperative of Puget Sound in Seattle. "Improved doesn’t mean good," he says. "There is a sizeable number of patients seen in primary care whose problems do not resolve well even after a couple of months."

Cherkin found the following predictors of poor outcomes at seven weeks:

• younger age;

• depression;

• pain below the knee.

Cherkin concludes that "physicians should be cautious in the prognostic information they give their patients," noting that on average, patients are mostly satisfied with the symptoms three weeks after treatment but that a third of patients still have significant problems after seven or more weeks.

References

1. Cherkin DC, Deyo RA, Street JH, et al. Predicting poor outcomes for back pain seen in primary care using patients’ own criteria. Spine 1996; 21:2,900-2,907.

2. Chavannes AW, Gubbels J, Post D, et al. Acute low back pain: Patient’s perceptions of pain four weeks after initial diagnosis and treatment in general practice. Journal of the Royal College of General Practitioners 1986; 36:271-273.