Exploring the origin of pain subclassification, with emphasis on low back pain: a systematic scoping review.

Mary-Anne Jess, Sharon Hamilton, Cormac Ryan, Shaun Wellburn, Jen Alexanders, Dan Spence, Denis Martin

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Objective: This scoping review aimed to explore the different working definitions being used for the duration of acute, subacute and chronic pain, with emphasis on low back pain (LBP) and establish where these definitions originated and the rationale provided for the timeframes used.

Introduction: 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 LBP patients 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 in order to provide an understanding of how these variations were derived.

Eligibility criteria: All study designs were included provided they gave a rationale for the duration that they used. Studies that included participants with LBP were the focus of this review. Sources that included children or other specific pain pathologies, for example cancer pain, were excluded.

Methods: The following databases were searched: MEDLINE, EMBASE, CINAHL and PsycINFO, from the start of each database until 18th September 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 list of studies to find the original source. It emerged that some original sources overlapped with general pain duration literature, this meant a deviation from the scoping review protocol, which was originally intended to focus on LBP duration definitions only. Data extraction was undertaken using a charting table developed specifically for the review objectives. The findings were presented using narrative synthesis.

Results: Nineteen records were included in this review. These 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 was extracted from the included studies and categorized into four themes, based on the origin of the classification of the duration. The themes included work/ employment setting, empirical studies, expert reasoning and pathophysiological explanation.

Conclusions: This scoping review compiled the existing literature on the working definitions of duration of acute, subacute and chronic LBP 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 LBP. 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 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 LBP.

Keywords Acute; chronic; definitions; low back pain; pain; subacute
Original languageEnglish
Article numberJBISRIR-D-19-00383R1
JournalJBI Database of Systematic Reviews and Implementation Reports
Publication statusAccepted/In press - 19 Jun 2020


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