Prevalence rates grew by 17% globally between 2005 and 2015 (Hurwitz 2018). A first episode of low back pain occurring within a year is estimated to occur between 6.3% and 15.4% of the time, with estimates for the incidence of any episode occurring within a year as high as 36%. In the general population, low back pain is thought to affect 23.2% of people within a month (Hoy D et al, 2010). Low back pain is more common as people age; estimates for prevalence at age 80 range as high as 40% in men and 35% in women (Hoy D et al, 2014). Further increases are expected, particularly in low- and middle-income countries (Hartvigsen J, et al 2018). LBP is currently considered “normal” in society, but it is more common in high-income countries (Hoy D, et al 2012). As a result, the prevalence of LBP is influenced by socio-cultural and economic factors. Low back pain is a symptom that is commonly described as pain between the bottom ribs and the buttock creases (Dionne CE, et al 2008).

Now let’s discuss “natural history”:

The acute–chronic dichotomy was the conventional view of back pain. An individual’s back pain experience may span their entire life. Back pain is a recurring ailment that is “characterised by variety and change rather than an acute, self-limiting incident, for which classifications of acute and chronic pain based on a single episode are insufficient.” Chronic back pain, which is defined as back pain that occurs at least half the days in a prolonged period of time, is a common condition (Von Korff and Saunders 1 996). It is generally said that most people have a positive prognosis. (Klaber Moffett et al. 1995; Evans and Richards 1996; Waddell 1994): Regardless of the type of treatment received or lack thereof, “80 to 90% of bouts of low back pain resolve in around 6 weeks” (Waddell 1987). However, Recent epidemiological data are refuted, and a picture of the natural history of back pain that predicts the majority will suffer a brief self-limiting episode overstates the experience of many people with this issue.

Indeed, a large majority of acute episodes of back pain end promptly and spontaneously (Coste et al. 1 994; Carey et al. 1995a). While most patients only saw their doctor once or twice for the issue, it was discovered that 75% of them were still experiencing symptoms one year later (Croft et al. 1 998). According to studies, about 30–40% of samples have been shown to be fully resolved at two to three months, with little further improvement at six or twelve months (Cherkin et al. 1996a; Philips and Grant 1991; Klenerman et al. 1995).

Recurrences are quite frequent, occurring in roughly three-quarters of samples one year after commencement (Klenerman et al. 1995; van den Hoogen et al. 1998). Von Korff et al. (1993) discovered that the majority of patients with both recent and nonrecent starts of back problems reported discomfort in the previous month (69% and 82%, respectively) in a large cohort of primary care patients investigated one year after seeking medical treatment for back pain. Only 21% of people with newly developing problems reported being pain-free in the preceding month; only 12% of people with more chronic problems reported being pain-free in the previous month.

The takeaway is that low back pain in the community is characterised by recurrences, exacerbations, and persistence in any given year (Croft et al. 1997).

Many people continue to endure back pain after they have recovered from an acute bout. A history of prior episodes is the main known risk factor for developing back pain (Croft et al. 1997; Shekelle 1997; Smedley et al. 1997). More than one-third of people with back pain have a long-term issue, and many recurrences are common (Croft et al. 1997; Evans and Richards 1996; Waddell 1994; Papageorgiou and Rigby 1991; Linton et al. 1998; Brown et al. 1998; Szpalski et al. 1995; Heliovaara et al. 1989; Toroptsova et al. 1995).

The findings suggest that the frequently cited quick recovery from back pain does not match the experiences of many people and that the distinction between chronic and acute back pain sufferers is a false dichotomy.

“Low back pain should be considered a chronic problem with an ad hoc pattern of grumbling symptoms and intervals of comparatively pain- and disability-free time interspersed with acute episodes, exacerbations, and recurrences” (Croft eL al. 1998).

Let’s discuss “disability”:

There are various types of back pain. Individual differences exist in the severity, functional impairment, and persistence of symptoms (von Korff et al. 1990). About 40% of those with the condition have reported persistent symptoms, including 10% of those with chronic, incapacitating back pain (Croft et al. 1997; Evans and Richards 1996; Fordyce 1995; Waddell 1994; Linton et aL 1998; Szpalski et al. 1995; Heliovaara et al. 1989; Toroptsova et al. 1995; Carey et al. 2000). Even among people who have ongoing symptoms, there are considerable variations in levels of disability.

To sum up:

• A heterogeneous and dynamic condition is described by the symptom of back discomfort.
• After the first several months, the natural improvement rate stabilises, and resolution becomes much less likely. In up to one-third of fresh episodes, the symptom duration is prolonged.
• The absence of clinical follow-up gives the false impression that problems are resolved consistently, which is not supported by more exacting study techniques.
• Back pain-related disabilities have changed over time.
• Back pain causes severe disability and work loss due to high incidence rates, which has a significant negative impact on both individuals and society.

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