Low back pain prognosis

Those back pain symptoms and signs recorded at the initial consultation which correlated with improvement or deterioration after a fortnight of treatment or control regimen are presented as short prognostic indicators. The correlations were strong, indicating only a limited ability to foretell what was to be. However there were some significant predictors of good short term prognosis including plain X-ray changes such as scoliosis, asymmetrical lumbo-sacral facet joints, and lumbar Schmorl's nodes. History of a short duration of the patients first ever episode of back pain and frequent attacks of back pain also gave an indication that matters might settle quickly in this episode, but did not exclude the possibility of recurrence. Features that appeared to serve no prognostic use included the patients' subjective pain severity assessment when seen initially and their comment as to whether they were getting better or worse in the month leading up to the first attendance. A poor short term prognosis was indicated by consumption of analgesics at the time of first attendance, difficulty getting off to sleep at night because of back pain and signs of nerve root compression including loss of reflex, hypoaesthesia, and motor weakness and limitation of straight leg raising. Weaker correlates included pain as an end point on straight leg raising irrespective of limitation of range of elevation; pain on lumbar flexion; limited range of sagittal lumbar mobility and a history of direct lumbar trauma. We suspect that ability to distinguish distinct low back pain diagnoses would provide a better indication of prognosis than can be afforded by any of the above mentioned measures applied to low back pain in general.