Natural Evolution of Nonspecific Low-Back Pain

  • Michel Benoist
  • Thibaut Lenoir


Information on the prognosis of low-back pain (LBP) is provided by a huge number of epidemiologic studies. This chapter summarizes the natural evolution of nonspecific LBP classified as a function of time: acute, subacute, and chronic, and analyzes the complex relation between pain, back functioning, and disability. It will be shown that the course of LBP at short and long term is not as favorable as originally claimed and that compensation and sick-listing have a deleterious effect on work resumption and recovery. In the second part of the chapter, the authors overview the various factors influencing the development of chronicity and discuss the therapeutic strategies. Schematically, the problem is to differentiate between those patients with a dominant central sensitization who should be directed to intensive rehabilitation and patients with persistence of the peripheral nociceptive input emanating from the degenerative spinal unit, for whom surgery could be considered.


Central Sensitization Widespread Pain Work Resumption Compensation Expense Work Incapacity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Health related quality of life


Low-back pain


Magnetic resonance imaging


Nociceptive spinal neuron


Roland disability questionnaire


Short from 36


Visual analog scale


  1. 1.
    Anderson GBJ (1997) The epidemiology of spinal disorders. In: Frymoyer JW (ed) The adult Spine. Lippincott-Raven, PhiladelphiaGoogle Scholar
  2. 2.
    Anderson GBJ (1999) Epidemiological features of chronic low-back pain. Lancet 354:581–585CrossRefGoogle Scholar
  3. 3.
    Bakker E, Verhagen A, Lucas C et al (2007) Spinal mechanical load: a predictor of persistent low-back pain? A prospective cohort study. Eur Spine J 16:933–941CrossRefPubMedGoogle Scholar
  4. 4.
    Bergquist-Ulmann M, Larson U (1977) Acute low-back pain in industry. A controlled prospective study with special reference to therapy and confounding factors. Acta Orthop Scand 170:11–17Google Scholar
  5. 5.
    Bigos SJ, Battie MC, Spengler DM et al (1991) A prospective study of work perception and psychosocial factors affecting the report of back injury. Spine 16:1–6CrossRefPubMedGoogle Scholar
  6. 6.
    Braithwaite J, White J, Salfuddin A et al (1998) Vertebral endplate changes on lumbar spine MRI. Correlation with pain reproduction on lumbar discography. Eur Spine J 7:363–368CrossRefPubMedGoogle Scholar
  7. 7.
    Brox JI, Sorensen R, Friis A et al (2003) Randomized control trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low-back pain and disc degeneration. Spine 28:1913–1921CrossRefPubMedGoogle Scholar
  8. 8.
    Carey J, Garrett J, Jackman A (2000) Beyond the good prognosis. Examination of an inception cohort of patients with chronic low-back pain. Spine 25:115–120CrossRefPubMedGoogle Scholar
  9. 9.
    Carragee EJ (2001) Psychological and functional profiles in select subjects with low-back pain. Spine J 1:198–204CrossRefPubMedGoogle Scholar
  10. 10.
    Cherkin D, Deyo R, Street J et al (1996) Predicting outcomes for back pain seen in primary care using patients’ own criteria. Spine 21:2900–2907CrossRefPubMedGoogle Scholar
  11. 11.
    Coste J, Lefrancois G, Guillemin F et al (2004) Prognosis and quality of life in patients with acute low-back pain: insights from a comprehensive inception cohort study. Arthritis Rheum 51:168–176CrossRefPubMedGoogle Scholar
  12. 12.
    Croft PR, Macfarlane GJ, Papageorgiou AC et al (1998) Outcome of low-back pain in general practice: a prospective study. BMJ 316(7141):1356–1359PubMedGoogle Scholar
  13. 13.
    Fairbank J, Frost H, Wilson-Mac Donald J et al (2005) Randomised controlled trial to compare surgical stabilization of the lumbar spine with an intensive rehabilitation program for patients with chronic low-back pain: the MRC spine stabilization trial. BMJ 330:485–492CrossRefGoogle Scholar
  14. 14.
    Freemont A, Peack TE, Goupille P et al (1997) Nerve ingrowth into diseased intervertebral disc in chronic back pain. Lancet 350:178–181CrossRefPubMedGoogle Scholar
  15. 15.
    Fritzell P, Haag O, Wessberg P et al (2001) Llumbar fusion versus non surgical treatment for chronic low-back pain: a multicenter randomized controlled trial from the sweedish lumbar spine study group. Spine 26:2521–2532CrossRefPubMedGoogle Scholar
  16. 16.
    Frymoyer JW (1988) Back pain and sciatica. N Engl J Med 318:291–300CrossRefPubMedGoogle Scholar
  17. 17.
    Frymoyer JW, Cats-Baril W (1987) Predictors of low-back pain disability. Clin Orthop 221:89–98PubMedGoogle Scholar
  18. 18.
    Gieseke T, Gracely RH, Masilo AH et al (2004) Evidence of augmented central pain processing in idiopathic chronic low-back pain. Arthritis Rheum 50:613–623CrossRefGoogle Scholar
  19. 19.
    Greenough CC (1993) Recovery from low-back pain 1–5 year follow-up of 287 injury related cases. Acta Orthop Scand 64(Suppl 254):1–64Google Scholar
  20. 20.
    Guzman J, Esmail R, Karjalainen K et al (2001) Multi­disciplinary rehabilitation for chronic low-back pain. Systematic review. BMJ 322:1511–1516CrossRefPubMedGoogle Scholar
  21. 21.
    Hansson TH, Hansson EK (2000) The effects of common medical interventions on pain, back function and work resumption in patients with chronic low-back pain. Spine 25:3055–3064CrossRefPubMedGoogle Scholar
  22. 22.
    Hansson EK, Hansson TH, Jonsson R (2006) Predictors for work ability and disability in men and women with low-back or neck problems. Eur Spine J 15:780–793CrossRefPubMedGoogle Scholar
  23. 23.
    Hestback L, Leboeuf-YDE C, Manniche C (2003) Low back-pain what is the long-term course? A review of studies of general patient populations. Eur Spine J 13:149–165Google Scholar
  24. 24.
    Ilharreborde B, Olivier E, Rillardon L et al (2005) Efficiency of total disc replacement arthroplasty in the treatment of chronic low-back pain. Presented at the Issls annual meeting. May 10–14, New York, USAGoogle Scholar
  25. 25.
    Klenerman L, Slade PD, Stanley M et al (1995) Predicting long term functional limitations among back pain patients in a general practice setting. Spine 20:478–484CrossRefPubMedGoogle Scholar
  26. 26.
    Leavitt F (1992) The physical exertion factor in compensable work injuries. A hidden flaw in previous research. Spine 17:307–310CrossRefPubMedGoogle Scholar
  27. 27.
    Nachemson A (2004) The evidence base for treatment of not degenerative disc disease but back pain. In: Gunzburg R, Spaslski M, Anderson GBJ (eds) Degenerative disc disease. Lippincott Williams and Wilkins, PhiladelphiaGoogle Scholar
  28. 28.
    Pedersen PA (1981) Prognostic indicators in low-back pain. JR Coll Gen Pract 31:209–216Google Scholar
  29. 29.
    Pengel L, Herbert R, Maher C et al (2003) Acute low-back pain: systematic review of its prognosis. BMJ 327(7410):323–327CrossRefPubMedGoogle Scholar
  30. 30.
    Philips H, Grant L (1991) Acute back pain. A psychological analysis. Behav Res Ther 29:429–434CrossRefPubMedGoogle Scholar
  31. 31.
    Roberts S, Eisenstein SM, Menage Y (1995) Mechano-receptors in intervertebral discs. Morphology, distribution and neuropeptides. Spine 20:2645–2651Google Scholar
  32. 32.
    Roland M, Morris R (1983) A study of the natural history of low-back pain part II: development of guidelines for trials of treatment in primary care. Spine 8:145–150CrossRefPubMedGoogle Scholar
  33. 33.
    Shenk P, Lanblit HJ et al (2007) Symptomatology of recurrent low back pain in nursing and administrative professions. Eur Spine J 16:1789–1898CrossRefGoogle Scholar
  34. 34.
    Spitzer WO, Leblanc FE, Dupuis M et al (1987) Scientific approach to the assessment and management of activity-related spinal disorders: a monograph for clinicians. Report of the Quebec Task force on spinal disorders. Spine 12:51–559Google Scholar
  35. 35.
    Takahashi H, Suguro T, Okazima Y et al (1996) Inflammatory cytokines in the herniated disc of the lumbar spine. Spine 21:218–224CrossRefPubMedGoogle Scholar
  36. 36.
    Thomas E, Silman AJ, Croft P et al (1999) Predicting who develops chronic low-back pain in primary care: a prospective study. BMJ 318:1662–1667PubMedGoogle Scholar
  37. 37.
    Tulder MW VAN, Koew BM, Bouter LM (1997) Management of chronic non specific low back pain in primary care: a descriptive study. Spine 22:76–82CrossRefPubMedGoogle Scholar
  38. 38.
    van den Hoogen H, Koes B, Deville W et al (1997) The prognosis of low-back pain in general practice. Spine 22:1515–1521CrossRefPubMedGoogle Scholar
  39. 39.
    Van Doorn T (1995) Low back disability among self employed dentists, veterinarians, physicians and physical therapists in The Netherlands. Acta Orthop Scand 66(Suppl 263):1–64Google Scholar
  40. 40.
    Vital JM, Gille O, Pointillart V et al (2003) Course of Modic I, 6 months after lumbar posterior osteosynthesis. Spine 28:715–720CrossRefPubMedGoogle Scholar
  41. 41.
    Von Korff M, Saunders K (1996) The course of back pain in primary care. Spine 21:2833–2837CrossRefPubMedGoogle Scholar
  42. 42.
    Von Korff M, Deyo RA, Cherkin D (1993) Back pain in primary care. Outcomes at 1 year. Spine 18:855–862CrossRefGoogle Scholar
  43. 43.
    Waddell G (1987) A new clinical model for the treatment of low back pain. Spine 12:632–644CrossRefPubMedGoogle Scholar
  44. 44.
    Waddell G (1992) Biopsychosocial analysis of low-back pain. Baillere Clin Rheumatol 6:523–557CrossRefGoogle Scholar
  45. 45.
    Werhaupt O, Zanetti M, Hodler J (2001) Relevance of endplates abnormalities at MRI imaging. Radiology 218:420–427Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.University of Paris VII, Hôpital BeaujonClichyFrance

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