Definitions of Chronic Low Back Pain From a Scoping Review, and Analyses of Narratives and Self-Reported Health of Adults With Low Back Pain

Abstract

Among those with low back pain (LBP), individuals with chronic LBP (CLBP) face different treatment recommendations and incur the majority of suffering and costs. However, the way CLBP has been defined varies greatly. This study used a scoping review and qualitative and quantitative analyses of data from LBP patients to explore this variation. CLBP in most recent randomized controlled trials (RCTs) was defined by duration of pain, most commonly ≥3 months. However, individuals with LBP most often define CLBP by frequency. CLBP has also been defined using a combination of duration and frequency (16% of RCTs and 20% of individuals), including 6% of recent RCTs that followed the NIH Pain Consortium research task force (RTF) definition. Although not a defining characteristic of CLBP for individuals, almost 15% of recent RCTs required CLBP to have a healthcare provider diagnosis. In our LBP sample moving from ≥3 months to the RTF definition reduced the CLBP group size by 25% and resulted in a group that used more pain management options and reported worse health across all outcome measures. A pain duration definition offers ease of application. However, refinements to this definition (eg, RTF) can identify those who may be better intervention targets. PERSPECTIVE: This article presents the definitions used for CLBP by researchers and individuals, and the impact of these definitions on pain management and health outcomes. This information may help researchers choose better study inclusion criteria and clinicians to better understand their patients' beliefs about CLBP.

Keywords: Chronic low back pain; back pain outcomes; pain management; qualitative analysis; scoping review.

Figure 1.

Overlap of different definitions of chronic low back pain in a population with nonspecific low back pain ≥3 Months Duration = Response of at least 3 months or more to “How long has low back pain been an ongoing problem for you?” RTF = NIH Pain Consortium research task force definition: responses of at least 3 months or more to “How long has low back pain been an ongoing problem for you?” AND at least half the days or every day to “How often has low back pain been an ongoing problem for you in the last 6 months?” Individual Identified = Response of “Yes” to “Do you think that your back pain is chronic?” Provider Identified = Response of “Yes” to “Has a health provider told you that your pain is chronic?”