School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
Institute of Bone and Joint Research/The Kolling Institute, Sydney Medical School, The University of Sydney, Sydney, Australia.
Pain Med. 2020 Jan 1;21(1):13-20. doi: 10.1093/pm/pnz021.
For many, low back pain (LBP) is a lifelong condition with symptoms varying over time. Previous studies have investigated long-term risk factors and triggers for onset of LBP. No study has examined causes for less distinct fluctuations of symptoms, such as "flares," which individuals with LBP identify as a significant and worrisome part of LBP. As little is known about what triggers this type of fluctuation, we aimed to investigate individuals' perspectives on LBP flare triggers.
We conducted an online survey of 130 people with LBP, asking what they think triggers their flares. Data were qualitatively examined using content analysis.
Most participants identified biomedical (84.8%) triggers, endorsing physical/biological factors to explain the flare occurrence. Themes included active movements (35% of participants), static postures (28.1%), overdoing a task (5.3%), biomechanical dysfunction (4.4%), comorbidities (4%), lack of exercise (3.3%), work (1.8%), and medications (1.5%). Nonbiomedical triggers were reported by 15.2% and included psychosocial and contextual factors, including psychological state (6%), weather (5%), sleep (2%), diet (1.2%), and fatigue (1%). These results indicate that individuals consider biomedical factors to be the main triggers of LBP flares, but some acknowledge nonbiomedical triggers.
Study findings contrast with current pain theories, which suggest that there is a need for a reduced emphasis on biomedical causes of LBP pain, especially when persistent. Recognition of patients' views on causes of LBP flares is crucial to better guide clinical practice and inform further research. The validity of triggers identified by LBP patients requires further investigation.
对许多人来说，腰痛（LBP）是一种终身疾病，症状随时间而变化。先前的研究调查了 LBP 的长期风险因素和发病诱因。尚无研究探讨导致症状不太明显波动的原因，例如“发作”，患有 LBP 的个体将其视为 LBP 的一个重要且令人担忧的部分。由于对这种类型的波动的触发因素知之甚少，我们旨在调查个体对 LBP 发作诱因的看法。
我们对 130 名患有 LBP 的人进行了在线调查，询问他们认为什么会引发发作。使用内容分析法对数据进行定性检查。
大多数参与者确定了生物医学（84.8%）诱因，赞同物理/生物学因素来解释发作的发生。主题包括主动运动（35%的参与者）、静态姿势（28.1%）、过度劳累（5.3%）、生物力学功能障碍（4.4%）、合并症（4%）、缺乏运动（3.3%）、工作（1.8%）和药物（1.5%）。15.2%的人报告了非生物医学诱因，包括心理社会和环境因素，包括心理状态（6%）、天气（5%）、睡眠（2%）、饮食（1.2%）和疲劳（1%）。这些结果表明，个体认为生物医学因素是 LBP 发作的主要诱因，但也有一些人承认非生物医学诱因。
研究结果与当前的疼痛理论形成对比，这些理论表明，需要减少对生物医学原因引起的 LBP 疼痛的重视，尤其是当疼痛持续存在时。认识到患者对 LBP 发作原因的看法对于更好地指导临床实践和为进一步研究提供信息至关重要。LBP 患者确定的诱因的有效性需要进一步调查。
