DEFINING LOW BACK FLARE: IT'S NOT AS SIMPLE AS AN INCREASE IN PAIN

Setchell J.¹, Costa N.¹, Ferriera M.², Makovey J.², Nielsen M.¹, Hodges P.¹

¹University of Queensland, Brisbane, Australia, ²Sydney Medical School Central, The University of Sydney, The George Institute for Global Health & Institute of Bone and Joint Research/The Kolling Institute, Sydney, Australia

Background: Low back pain (LBP) is a lifelong problem for most and symptom flares can have a great impact on the lives of individuals with LBP. One of the main goals of treatment for LBP is arguably to decrease pain flares in both frequency and severity. However, this goal is problematic with little research and no consensus regarding what constitutes a flare. This may be because LBP symptoms varying in intensity and duration over time (in both acute episodes and when the condition is persistent) and not all fluctuations may be considered important. Previous research in other musculoskeletal conditions has found patients and clinicians define symptom flare differently. The perspectives of individuals with LBP have received limited research attention in understanding LBP flare.

Purpose: To address these issues we aimed to understand how individuals with LBP conceptualise flare.

Methods: We used a primarily qualitative study design with a small quantitative component. In 2015, we conducted an online survey of 130 individuals with LBP living in Australia. The topics explored were: interpretations of what the term flare means, how much change in LBP severity would be considered a flare, what features would be considered to be part of a flare and whether ‘increase’ and ‘flare’ were considered synonymous. The first three topics were analysed qualitatively using content and thematic analysis and, as the fourth topic produced numerical outputs, data were analysed using descriptive statistics.

Results: Considering the results of these analyses together we found that individuals with LBP described flare as more complex than simply an increase in pain. Participants identified many aspects of a flare to be important, including changes in: 1) pain and other uncomfortable sensations, 2) the area, quality or duration of symptoms, 3) function, and 4) emotional and cognitive factors. Flare was also discussed as a change that was difficult to settle.

Conclusion(s): Our results showed it is insufficient to define flare as simply an increase in pain and that may result in confusion of flare with other aspects of LBP. Based on views of people with LBP, we suggest it is important to develop a broader definition of flare than has been traditionally used. This definition should take into account that flare is more complex than simply an increase in pain. Inclusion of the multiple factors identified in this study should be considered.

Implications: Consideration of patients’ understandings of LBP flare is an essential step towards a person-centred understanding of the term flare. This broader understanding of flare suggested by the findings of this study should help to more accurately investigate causes of flare, and assist efforts to predict and prevent LBP flare. This will have applications in clinical, education and research settings.

Funding acknowledgements: This study was funded by the NHMRC (Australia). MLF holds a Sydney Medical Foundation Fellowship.

Topic: Musculoskeletal: spine

Ethics approval: Ethics approval was granted by The University of Queensland.

All authors, affiliations and abstracts have been published as submitted.