Highlights
- •Low back pain fluctuates, but not all are considered important by patients.
- •A low back pain “flare” is a meaningful fluctuation but is poorly defined, limiting its usefulness.
- •Flare was defined by a multiphase process with consumer input and expert consensus.
- •A low back pain flare is defined by concepts of worsening of symptoms plus broader aspects.
- •A flare involves impact on function and/or emotions.
Abstract
Low back pain (LBP) varies over time. Consumers, clinicians, and researchers use various
terms to describe LBP fluctuations, such as episodes, recurrences and flares. Although
“flare” is use commonly, there is no consensus on how it is defined. This study aimed
to obtain consensus for a LBP flare definition using a mixed-method approach. Step
1 involved the derivation of a preliminary candidate flare definition based on thematic
analysis of views of 130 consumers in consultation with an expert consumer writer.
In step 2, a workshop was conducted to incorporate perspectives of 19 LBP experts
into the preliminary flare definition, which resulted in 2 alternative LBP flare definitions.
Step 3 refined the definition using a 2-round Delphi consensus with 50 experts in
musculoskeletal conditions. The definition favored by experts was further tested with
16 individuals with LBP in step 4, using the definition in three scenarios. This multiphase
study produced a definition of LBP flare that distinguishes it from other LBP fluctuations,
represents consumers’ views, involves expert consensus, and is understandable by consumers
in clinical and research contexts: “A flare-up is a worsening of your condition that
lasts from hours to weeks that is difficult to tolerate and generally impacts your
usual activities and/or emotions.”
Perspective: A multiphase process, incorporating consumers’ views and expert consensus,
produced a definition of LBP flare that distinguishes it from other LBP fluctuations.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of PainAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Trajectories of low back pain.Best Pract Res Clin Rheumatol. 2013; 27: 601-612
- Low back pain: A call for action.Lancet. 2018; 391: 2384-2388
- Lives on hold: A qualitative synthesis exploring the experience of chronic low-back pain.Clin J Pain. 2013; 29: 907-916
- Identifying flares in rheumatoid arthritis: Reliability and construct validation of the OMERACT RA Flare Core Domain Set.RMD Open. 2016; 2
- ‘Clear as mud’: Toward greater clarity in generic qualitative research.Int J Qual Methods. 2003; 2: 1-13
- Trajectories and predictors of the long-term course of low back pain: Cohort study with 5-year follow-up.Pain. 2018; 159: 252-260
- Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013.Lancet. 2015; 386: 743-800
- What concerns workers with low back pain? Findings of a qualitative study of patients referred for rehabilitation.J Occup Rehabil. 2010; 20: 472-480
- How is symptom flare defined in musculoskeletal conditions: A systematic review.Semin Arthritis Rheum. 2018; 48: 302-317
- Outcome of low back pain in general practice: A prospective study.BMJ. 1998; 316: 1356
- Defining flare in osteoarthritis of the hip and knee: A systematic literature review — OMERACT Virtual Special Interest Group.J Rheumatol. 2017; 44: 1920-1927
- Episodes of low back pain: A proposal for uniform definitions to be used in research.Spine. 2002; 27: 2409-2416
- Defining consensus: A systematic review recommends methodologic criteria for reporting of Delphi studies.J Clin Epidemiol. 2014; 67: 401-409
- Long-term trajectories of back pain: Cohort study with 7-year follow-up.BMJ Open. 2013; 3
- Low back pain across the life course.Best Pract Res Clin Rheumatol. 2013; 27: 591-600
- Developing a provisional definition of flare in patients with established gout.Arthritis Rheum. 2012; 64: 1508-1517
- What low back pain is why we need to pay attention.Lancet. 2018; 391: 2356-2367
- What have we learned from ten years of trajectory research in low back pain?.BMC Musculoskelet Disord. 2016; 17: 220
- It's not just the joints, it's the whole thing: Qualitative analysis of patients' experience of flare in psoriatic arthritis.Rheumatology. 2015; 54: 1448-1453
- Development of a flare instrument for use in psoriatic disease: A report from the 2015 GRAPPA Annual Meeting.J Rheumatol. 2016; 43: 974-978
- Characterizing pain flares from the perspective of individuals with symptomatic knee osteoarthritis.Arthritis Care Res. 2015; 67: 1103-1111
- What constitutes back pain flare? A cross sectional survey of individuals with low back pain.Scand J Pain. 2017;
- Definitions of recurrence of an episode of low back pain: A systematic review.Spine. 2009; 34: E316-E322
- A modified Delphi approach to standardize low back pain recurrence terminology.Eur Spine J. 2011; 20: 744-752
- Acute low back pain is marked by variability: An internet-based pilot study.BMC Musculoskelet Disord. 2011; 12 (220-220)
- Prevalence and characteristics of flare-ups of chronic nonspecific back pain in primary care: A telephone survey.Clin J Pain. 2012; 28: 573-580
- The course of chronic and recurrent low back pain in the general population.Pain. 2010; 150: 451-457
- Fibromyalgia flares: A qualitative analysis.Pain Med. 2016; 17: 463-468
- Studying the natural history of back pain.Spine. 1994; 19: 2041S-2046S
- Workers' perspectives on low back pain recurrence: "it comes and goes and comes and goes, but it's always there.Pain. 2011; 152: 204-211
Article info
Publication history
Published online: March 20, 2019
Footnotes
Supported by a Program grant (APP1091302); Centre of Research Excellence grant (APP1079078) and Fellowships (PH – APP1102905; MLF – APP1143593; DJH - APP632922) from the National Health and Medical Research Council (NHMRC) of Australia. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
The authors have no conflicts of interest to declare.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
Identification
Copyright
© 2019 by the American Pain Society
