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. 2015 Mar;33(1):27-32.
doi: 10.3109/02813432.2015.1006462. Epub 2015 Feb 19.

Radiating low back pain in general practice: incidence, prevalence, diagnosis, and long-term clinical course of illness

Antje Spijker-Huiges  1 , Feikje Groenhof, Jan C Winters, Marten van Wijhe, Klaas H Groenier, Klaas van der Meer
Affiliations

Radiating low back pain in general practice: incidence, prevalence, diagnosis, and long-term clinical course of illness

Antje Spijker-Huiges et al. Scand J Prim Health Care. 2015 Mar.

Abstract

Objective: The aim of this study was to calculate the incidence and prevalence of radiating low back pain, to explore the long-term clinical course of radiating low back pain including the influence of radiculopathy (in a subsample of the study population) and non-radiating low back pain thereon, and to describe general practitioners' (GPs') treatment strategies for radiating low back pain.

Design: A historic prospective cohort study.

Setting: Dutch general practice.

Subjects: Patients over 18 years of age with a first episode of radiating low back pain, registered by the ICPC code L86.

Main outcome measures: Incidence and prevalence, clinical course of illness, initial diagnoses established by the GPs, and treatment strategies.

Results: Mean incidence was 9.4 and mean prevalence was 17.2 per 1000 person years. In total, 390 patients had 1193 contacts with their GPs; 50% had only one contact with their GP. Consultation rates were higher in patients with a history of non-radiating low back pain and in patients with a diagnosis of radiculopathy in the first five years. In this study's subsample of 103 patients, L86 episodes represented radiculopathy in 50% of cases. Medication was prescribed to 64% of patients, mostly NSAIDs. Some 53% of patients were referred, mainly to physiotherapists and neurologists; 9% of patients underwent surgery.

Conclusion: Watchful waiting seems to be sufficient general practice care in most cases of radiating low back pain. Further research should be focused on clarifying the relationship between radicular radiating low back pain, non-radicular radiating low back pain, and non-radiating low back pain.

Keywords: General practice; incidence; long-term care; lumbago; pain treatment; prevalence; sciatica; the Netherlands.

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Figures

Figure 1.
Figure 1.
Patient selection flow schedule.
Figure 2.
Figure 2.
Probability of GP consultation for radiating low back pain which indicates episode length (ICPC L86) during 10 years of follow up stratified by gender (A), age (B), pre-history of low back pain (C), and initial diagnosis of radiculopathy or not (D) (RNG population 18 + years, 1998–2008).
Figure 3.
Figure 3.
Treatment strategies employed by the GPs for each subsequent contact in the first episode of radiating low back pain (ICPC L86), up to the 10th contact (RNG population 18 + years, 1998–2008).
See this image and copyright information in PMC

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