School of Health and Social Care, Teesside University, Middlesbrough, UK.
Teesside Centre for Evidence-Informed Practice: A JBI Affiliated Group, Middlesbrough, UK.
JBI Evid Synth. 2021 Feb;19(2):308-340. doi: 10.11124/JBISRIR-D-19-00383.
This scoping review aimed to explore the different working definitions for the duration of acute, subacute, and chronic pain, with emphasis on low back pain, and to establish where these definitions originated and the rationale provided for the time frames used.
From a global perspective, low back pain is a major social and economic problem. One of the most commonly used methods to stratify and manage low back pain is the traditional duration-based classification (acute, subacute, and chronic). Where these time points lie to differentiate these transitions continues to be debated within the scientific community, which may engender a degree of heterogeneity in study findings. Therefore, applying these findings to clinical practice may be somewhat challenging. This review encapsulates the historical origins of the different duration categories to provide an understanding of how these variations were derived.
Studies that included participants with low back pain were the focus of this review. Sources that included children or other specific pain pathologies, such as cancer pain, were excluded. The main concept of interest was that the publication proposed an original definition of the duration of acute, subacute, or chronic low back pain. All study designs were included provided they gave a rationale for the duration that they used.
The following databases were searched: MEDLINE, Embase, CINAHL, and PsycINFO, from the inception of each database until September 18, 2019. This review was limited to studies published in English. Two independent reviewers screened the retrieved articles against the eligibility criteria. Additional studies were searched from the reference lists of studies to find the original source. Some original sources overlapped with general pain duration literature. This led to a deviation from the scoping review protocol, which originally intended to focus on definitions of low back pain duration only. Data extraction was undertaken using a charting table developed specifically for the review objectives. The findings were presented using narrative synthesis.
Nineteen records were included in this review, and comprised three book chapters, four review articles, four articles that arose following pain expert group discussions, seven primary research studies, and a spinal guideline. Data were extracted from the included studies and categorized into four themes based on the origin of the classification of the duration. The themes included i) work/employment setting, ii) empirical studies, iii) expert reasoning, and iv) pathophysiological explanation.
This scoping review compiled the existing literature on the working definitions of the duration of acute, subacute, and chronic low back pain and found a wide variation. These ranged from seven days, 14 days, and seven weeks for the acute and subacute transition points, and seven weeks to three years for chronic low back pain. The duration definitions specifically referring to the general pain literature focused on three and/or six months for the transition to chronic. Better integration of reasoning between the identified themes could facilitate the establishment of more ideal duration definitions in the future. Although inconclusive, the definition most commonly cited, with most consensus, was three months for the transition to chronic low back pain.
本范围综述旨在探讨急性、亚急性和慢性疼痛持续时间的不同工作定义，重点是腰痛，并确定这些定义的起源以及用于时间框架的基本原理。
从全球角度来看，腰痛是一个重大的社会和经济问题。对腰痛进行分层和管理的最常用方法之一是传统的基于时间的分类（急性、亚急性和慢性）。科学界仍在争论这些时间点如何区分这些转变，这可能会导致研究结果存在一定程度的异质性。因此，将这些发现应用于临床实践可能具有一定挑战性。本综述总结了不同持续时间类别的历史起源，以了解这些变化是如何产生的。
本综述的重点是纳入腰痛患者的研究。排除了包括儿童或其他特定疼痛病理（如癌症疼痛）的来源。主要关注的概念是出版物提出了急性、亚急性或慢性腰痛持续时间的原始定义。所有研究设计都包括在内，只要它们给出了使用的持续时间的基本原理。
检索了以下数据库：MEDLINE、Embase、CINAHL 和 PsycINFO，从每个数据库的创建到 2019 年 9 月 18 日。本综述仅限于发表在英语文献中的研究。两名独立的审查员根据纳入标准筛选检索到的文章。还从研究的参考文献中搜索了其他研究以找到原始来源。一些原始来源与一般疼痛持续时间文献重叠。这导致偏离了范围综述的方案，该方案最初旨在仅关注腰痛持续时间的定义。使用专门为审查目标开发的图表表进行数据提取。使用叙述性综合呈现研究结果。
本综述共纳入 19 项记录，包括三章书、四篇综述文章、四篇源自疼痛专家小组讨论的文章、七项原始研究和一份脊柱指南。从纳入的研究中提取数据，并根据分类的起源分为四个主题。这些主题包括 i）工作/就业环境，ii）实证研究，iii）专家推理，和 iv）病理生理学解释。
本范围综述综述了急性、亚急性和慢性腰痛持续时间的现有文献中的工作定义，并发现了广泛的差异。这些范围从急性和亚急性转变点的七天、十四天和七周，到慢性腰痛的七周至三年。专门针对一般疼痛文献的持续时间定义侧重于三到六个月的慢性转变。更好地整合确定主题之间的推理，可以促进未来建立更理想的持续时间定义。尽管没有定论，但最常被引用且最具共识的定义是慢性腰痛转变的三个月。
