SPONTANEOUS ONSET OF BACK PAIN

Objectives: To assess the frequency with which patients attribute low back pain to spontaneous onset. Design: A consecutive sample of two di stinct groups of patients seeking treatment for back pain: those witho ut need to identify cause (study group, n = 4,689) and those required to report a specific event to qualify for benefits paid for by a third party (compensated group, n = 6,687). Setting: Active exercise-based back pain rehabilitation clinics. Summary of Background Data: Research on the natural history of back pain has revealed frequent reports of spontaneous recovery, usually within 8-12 weeks after onset. There is little comparable literature pertaining to the report of spontaneous o nset. Methods: Data were collected for two groups of consecutive patie nts who attended for initial assessments of their back pain at 16 Cana dian Back Institute locations, between May 1, 1994 and February 28, 19 95. Patient responses were collected using a standardized, professiona lly administered questionnaire. Results: In the group without need to identify cause, 66.7% of patients could not identify an event producin g their symptoms. For those required to report a specific event, only 9.8% of patients failed to attribute cause. Multivariate logistic regr ession revealed that the required-to-report group was approximately 15 times more likely to report an event (odds ratio = 14.95; 95% confide nce interval = 13.44, 16.65) than the study group; those pursuing liti gation were more than 2.5 times more likely to report a causative even t (odds ratio = 2.68; 95% confidence interval = 2.09, 3.49). Conclusio ns: Back pain occurred spontaneously in approximately 67% of patients seeking treatment in the study group. The authors consider spontaneous onset to be part of the natural history of back pain for this group.