A new look at low back complaints in primary care - A RAMBAM Israeli Family Practice Research Network study

BACKGROUND. tow back pain (LBP) is one of the most frequent reasons patient s seek consultations in primary care, and it is a major cause of disability . Our research examines the natural history of LBP and the prediction of ch ronicity in the context of patients presenting to family medicine clinics. METHODS. We performed a prospective cohort study of new episodes of LBP wit hin the framework of a national family practice research network. The setti ng was 28 primary care family practice clinics located throughout Israel. O f 238 eligible subjects, 219 (92%) completed the study. RESULTS. During the 2-month study period, 2 subjects were referred to the e mergency department and discharged, and 2 others were hospitalized. Forty-f ive percent did not require bed rest, and 38% of the employed were not abse nt from work. Seventy-one percent showed improvement in functional status; however, only 37% noted complete pain relief. Clinical and demographic data usually did not predict LBP-episode outcomes. The strongest predictors of chronicity were depression, history of job change due to LBP in the past, h istory of back contusion, lack of social support, family delegitimization o f patient's pain, dissatisfaction with first office visit, family history o f LBP or other chronic pain, coping style, and unemployment. CONCLUSIONS. The cohort patients displayed a relatively benign natural hist ory of LBP, matched by benign clinical behavior from their physicians. In I sraeli primary health care, acute LBP is infrequently associated with hospi talization or prolonged work absenteeism. Although most patients have funct ional improvement, pain often lingers. Almost all predictors of chronicity are psychosocial.