Patients often misplace blame for lower back pain

People suffering from lower back pain often think a specific moment of extreme exertion triggered their sudden discomfort, even though simple daily tasks can just as easily contribute, an Australian study suggests.

When researchers asked 999 adults what caused their back problems, about two thirds blamed a specific experience on the day their pain surfaced.

Because triggers for lower back pain can occur days or even weeks or months before the sudden onset of discomfort, however, it’s likely that many patients misplaced blame, said Dr. Scott Forseen, a back pain researcher at Georgia Regents University in Augusta.

“While acute back pain tends to have a good prognosis and will improve over time, failure to recognize red flags can have significant negative consequences,” Forseen, who wasn’t involved in the study, said by email.

Worldwide, lower back pain is a leading cause of disability, afflicting about one in 10 people, according to a recent estimate. The odds of developing this type of pain increase with age. It can often be treated with medication, exercise, heat or ice application, or sometimes with surgery.

And understanding what really may have triggered an episode of back pain may help people to avoid those causes in the future, according to the study authors, who were led by Patricia Parreira at the University of Sydney.

The researchers analyzed data from surveys completed by patients who went to the doctor seeking treatment. On average, study participants were about 45 years old and overweight. About 59% were male.

The study team looked at how often the patients named common, established back pain triggers, as well as less well-known triggers, and used the information to see how often patients under- or overestimated the harmful effects of certain triggers.

Among the common triggers for lower back pain researchers asked about were lifting heavy or hard to grasp loads, vigorous exercise, sex, fatigue or drinking alcohol. Participants also specified whether exposure to the trigger was immediately before the pain started or within the previous 24 hours.

Typically, the participants had around six previous episodes of lower back pain. Patients said the current flare up generally lasted about five days, including more than two days of reduced activity due to pain.

During the first 24 hours of the current bout of back problems, about half of participants rated their pain as severe, while another 16% described it as extremely severe. Almost all of them said the pain interfered with work.

Many participants reported experiencing one of the common causes of back pain on the day the flare up started. But only 17% of them recalled experiencing these triggers during the previous 24 hours.

“Common sense tells us that lifting heavy loads, awkward posture, vigorous activity and slips/trips/falls could cause back pain,” Forseen said. “These scenarios are commonly encountered in everyday experience, making it easier to tie the two together as cause and effect.”

It’s not surprising that the origins of pain that patients failed to acknowledge in the survey included alcohol consumption, sex, distraction and fatigue, he said.

“Answering in the affirmative on these items may be too embarrassing, may not make common sense, or may require the person to acknowledge some type of fault of their own,” Forseen said. “When we answer survey questions, we tend to answer in a manner that will be viewed favorably by others.”

One limitation of the study is its reliance on human recall, the authors acknowledge in the journal Pain, June 1.

“I think it is a mistaken notion that most low back pain is due to a specific event and that knowing this, there is something that could be done to prevent it,” said Dr. Steven Atlas, a quality improvement specialist at Massachusetts General Hospital and Harvard University in Boston.

Knowing the specific root of a medical problem is important when it will impact treatment, Atlas, who wasn’t involved in the study, said by email. It makes sense to test people for strep throat, for example, because this can be treated with penicillin.

But with back pain, pinpointing the culprit doesn’t make treatment more effective, he said. Most people will get the same benefit from pain medication, activity recommendations and education about how to manage the episode whether or not doctors know what caused the pain.

“The key question is whether such knowledge is actionable,” Atlas said. “Can it lead to changing behavior to prevent future episodes or can it direct treatment that results in quicker resolution of symptoms? For the most part, the answer to both of these questions is no.”