PainSci summary of Steffens 2015?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★★☆4-star ratings are for bigger/better studies and reviews published in more prestigious journals, with only quibbles. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
This fascinating experiment produced valuable data on potential triggers for episodes of acute low back pain.
Basically the researchers just a did a thorough and formal version of asking a lot of people — a thousand of them — what they were doing before their back pain started (as compared to other recent periods). They made an admirable effort to do this in a way that eliminated “recall bias,” but I am not completely confident they succeeded: people have strong ideas about what constitutes a risk factor for back pain, and people tend to perceive and remember what they want or expect to be true. Participants were asked to:
report exposure, including its time and duration, to each of the 12 putative triggers in the 96 hours preceding the onset of back pain. For example, for questions about manual tasks involving a heavy load would be as follows: so on the day of your back pain did you engage in any manual tasks involving a heavy load?
A lot of people are likely to remember it that way, because that’s what they already think causes back pain. The list of possibilities was also limited to classic putative risk factors, which means that if a risk factor isn’t a bit of a cliché, this study simply ignored it. I think that has real potential to confound the results here.
Nevertheless, there were strong signals and fascinating patterns here, and “the results of this study demonstrate for the first time that brief exposure to a range of physical and psychosocial factors can considerably increase the risk of an episode of acute back pain.” Here are some of the most notable findings:
- Being distracted was by far the biggest risk: patients were twenty-five times more likely to be distracted “during an activity or task” right before an episode of back pain than at other times in the preceding couple days.
- A distant second, “manual tasks” were risky — a broad category — but an “awkward posture” tops the list of more specific examples, and it was notably a greater risk factor than heavy/awkward lifting.
- Mornings are trouble! “Mornings were the most frequent time of day for back pain onset, with 35.2% of participants reporting pain onset between 7:00 AM and 10:00 AM. Only 3.7% of participants reported pain onset between mid- night and 5:00 AM, with a large increase in reports from 6:00 AM.”
- The risks of heavy lifting go down with age: “the odds associated with manual tasks involving heavy loads at age 60 years is more than 5 times smaller than at age 20 years.”
- Sexual intercourse and alcohol were not significant risk factors, with virtually no risk for sex.
original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
OBJECTIVE: To investigate a range of transient risk factors for an episode of sudden-onset, acute low back pain (LBP).
METHODS: This case-crossover study recruited 999 subjects with a new episode of acute LBP between October 2011 and November 2012 from 300 primary care clinics in Sydney, Australia. Each participant was asked to report exposure to 12 putative triggers over the 96 hours preceding the onset of back pain. Conditional logistic regression was used to estimate odds ratios (ORs) expressing the magnitude of increased risk with exposure to each trigger.
RESULTS: Exposure to a range of physical and psychosocial triggers significantly increased the risk of a new onset of LBP; ORs ranged from 2.7 (moderate or vigorous physical activity) to 25.0 (distracted during an activity or task). Age moderated the effect of exposure to heavy loads and sexual activity. The ORs for heavy loads for people ages 20, 40, or 60 years were 13.6, 6.0, and 2.7, respectively. The risk of developing back pain was greatest between 7:00 AM and noon.
CONCLUSION: Transient exposure to a number of modifiable physical and psychosocial triggers substantially increases risk for a new episode of LBP. Triggers previously evaluated in occupational injury studies, but never in LBP, have been shown to significantly increase risk. These results aid our understanding of the causes of LBP and can inform the development of new prevention approaches.
These four articles on PainScience.com cite Steffens 2015 as a source:
- PS Trigger Points & Myofascial Pain Syndrome — A guide to the unfinished science of muscle pain, with reviews of every theory and self-treatment and therapy option
- PS Does Posture Correction Matter? — Posture correction strategies and exercises … and some reasons not to care or bother
- PS Save Yourself from Low Back Pain! — Low back pain myths debunked and all your treatment options reviewed
- PS Morning Back Pain — A thorough review of possible causes for this frustrating symptom
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.
- The neck and headaches. Bogduk 2014 Neurol Clin.
- Agreement of self-reported items and clinically assessed nerve root involvement (or sciatica) in a primary care setting. Konstantinou 2012 Eur Spine J.
- Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. Morelli 2017 Am J Sports Med.
- Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. Paige 2017 JAMA.