Open AccessProspective Clinical Study on Natural History of Discogenic Low Back Pain at 4 Years of Follow-up
Author(s) -
Baogan Peng
Publication year - 2012
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2012/15/525
Subject(s) - medicine , low back pain , oswestry disability index , discography , natural history , back pain , prospective cohort study , lumbar disc disease , physical therapy , lumbar , degenerative disc disease , surgery , alternative medicine , pathology
Background: To accurately assess the effect of any therapy for treating discogenic lowback pain, the natural history of such pain should be known beforehand. However, untilnow, no pathological characteristic could be used to predict the disease course of lowback pain.Objective: To better instruct the clinical treatment of discogenic low back pain, aprospective clinical study was performed to observe the natural history of the disease.Study Design: A prospective clinical study during a 4-year follow-up period.Setting: The study was performed at a spinal center in China.Methods: A total of 279 patients with chronic low back pain were included from June2006 through October 2007. Using discography, 156 patients (56%) were diagnosed tohave discogenic back pain. A 101-point numerical rating scale (NRS) was used to assessthe back pain symptoms and the Oswestry Disability Index (ODI) was used to assess lumbarfunction.Results: Of the 156 patients, 131 (84%) completed the study at 4-year follow-up. At theend of follow-up, 17 patients (13.0%) had their low back pain symptoms alleviated andlumbar function improved; 10 patients (7.6%) were slightly improved; 16 patients (12.2%)had their symptoms aggravated; and 88 patients (67.2%) experienced the same pain anddisability as before. Although the average NRS and ODI scores obtained during the 4-yearfollow-up study gradually decreased, statistical significances were found in such changes(P < 0.05,and P < 0.05, respectively); however, the improvement rates of both pain (7.6%)and disability (5.2%) were very low.Limitations: The shortcoming of this study is its relatively small sample size.Conclusion: The present study indicated that the natural history of discogenic low backpain was chronic but persistent, and that the pain and disability in most patients did notimprove over time.Key words: Discogenic low back pain, chronic low back pain, lumbar discography, painfuldisc, black disc, disc degeneration, internal disc disruption, natural history, prognosis.