PERSISTENT BACK PAIN AND SCIATICA IN THE UNITED-STATES - PATIENT CHARACTERISTICS

Low back pain is an extremely common, seriously disabling,nonfatal pub lic health problem worldwide. The National Low Back Pain Study was a m ulticenter study of a large, heterogeneous group of patients who have been referred to either a neurosurgeon or an orthopedic surgeon for th e evaluation and treatment of a persistent complaint of low back pain. In this paper, we characterize persistent low back pain patients and their complaints, describe the impact of persistent low back pain on t he patients' functional and psychological status, report on the patien ts' medical characteristics, and identify treatments that are currentl y prescribed for these patients. Persistent low back pain is most comm on among people in their mid-to-late thirties and early-to-mid forties . The patients are mostly white, well educated, and generally affluent . The majority are gainfully employed, but some quit working because o f pain and those who do tend to be less educated, and more likely to b e involved in litigation. The average patient has had low back pain in termittently for 10 years. The pain is usually well localized but its severity varies considerably. Besides pain, most persistent low back p ain patients report a variety of motor and sensory deficits. Patients also report significant functional impairment at work, at play, and at home. The typical patient does not, however, display significant psyc hological distress. Most patients have consulted multiple health care providers, have received a variety of treatments, and have used a vari ety of medications to alleviate pain; a few have been subjected to mor e aggressive treatment measures including surgery, intradiscal therapy , and narcotic and psychoactive drugs. None of these treatments has be en effective. Physical examinations of these patients do not provide s ignificant clues for making a definitive diagnosis. Nonspecific abnorm alities such as muscle spasm, tenderness, and trigger points are quite common, but motor weakness and sensory deficits in the lower extremit ies, and reflex changes in the knees and ankles, are much less common. The classic combination of reflex changes, motor weakness, and sensor y deficits associated with specific protruded discs are extremely rare even though one of three patients had a diagnosis of disc herniation. Diagnostic imaging studies revealed that the majority of persistent l ow back pain patients have spondylotic abnormalities involving root co mpression or lumbar instability or both, with root compression as the primary cause of the complaint. Myofascial syndrome and lumbar instabi lity were the next most common diagnoses. After a thorough evaluation by specialists in spinal disorders, three of five persistent low back pain patients were prescribed an additional course of conservative the rapy, one of five was prescribed surgery, and the rest were prescribed no treatment. Persistent low back pain patients appear to be a distin ct group of low back pain patients who are different from patients who have similar nonpersistent acute symptoms and those who have the chro nic pain syndrome characterized by significant behavioral and psycholo gical co-morbidities.