The Relationship between Clinical Symptoms and Low Back Pain Syndromes
Hoffman* MD, Chris Gregg*
MSc, Greg McIntosh** MSc*and Hamilton Hall** MD
*TBI Health Group, Wellington, New Zealand
Canadian Back Institute Research Department, Toronto, Canada
The purpose of this study was to compare clinical characteristics
of low back pain (LBP) based on a syndrome approach to classification.
Methods: This retrospective study of prospectively collected
low back pain (LBP) cases was a collaborative effort of rehabilitation clinics
in New Zealand and Canada over a four year period.
All patients assessed were
classified into one of four distinct syndromes (patterns 1-4). Statistical analysis was conducted to
determine associations between symptomatic variables recorded at assessment (dominant pain site, numeric pain score, aggravating
and relieving activities, perceived function and neurological findings) and the
eventual diagnostic pattern.
Results: The sample group consisted of 1912
patients: Pattern1 = 1653 (86.5%), Pattern 2 =
196 (10.3%), Pattern 3 = 62 (3.2%), Pattern 4 = 1 (0.1%).
Patients classified as Pattern 3 were
more likely to report leg dominant pain (71%), compared to pattern 1 and 2.
Aggravating factors for each pattern
differed (p<0.01) and patients with Pattern 1 were more likely to aggravate
their back pain with flexion activities.
Relieving position of each pattern was significantly different (p<0.01)
with Pattern1 best reduced in extension (91%), Pattern 2 best reduced in flexion
(85%), and Pattern 3 most improved when lying down.
The neurological profile of each
pattern was significantly different (p<0.01). 27% of patients with Pattern 1
had at least one positive neurological finding compared to Pattern 2 (12%) and
Pattern 3 (72%).
There was no statistically significant
difference in baseline numeric pain rating between patterns.
Perceived level of functional ability
was significantly different between all three patterns (p<0.01) and Pattern 1
had the highest level of perceived functional capacity.
Conclusions: This international study contradicts a categorization of LBP as one homogeneous ‘non-specific’
entity. The findings of this study suggests
that LBP is heterogeneous in nature with recognizable and unique clinical markers.