Definitions of Chronic Low Back Pain From a Scoping Review, and Analyses of Narratives and Self-Reported Health of Adults With Low Back Pain

Published:October 22, 2022DOI:


      • Those with chronic (vs nonchronic) low back pain (LBP) face more suffering and costs.
      • However, what defines LBP as chronic varies widely.
      • Most recent randomized controlled trials defined chronic LBP by duration.
      • Most individuals with LBP define chronicity in terms of frequency.
      • Pain management behaviors and outcomes differ across groups meeting each definition.


      Among those with low back pain (LBP), individuals with chronic LBP (CLBP) face different treatment recommendations and incur the majority of suffering and costs. However, the way CLBP has been defined varies greatly. This study used a scoping review and qualitative and quantitative analyses of data from LBP patients to explore this variation. CLBP in most recent randomized controlled trials (RCTs) was defined by duration of pain, most commonly ≥3 months. However, individuals with LBP most often define CLBP by frequency. CLBP has also been defined using a combination of duration and frequency (16% of RCTs and 20% of individuals), including 6% of recent RCTs that followed the NIH Pain Consortium research task force (RTF) definition. Although not a defining characteristic of CLBP for individuals, almost 15% of recent RCTs required CLBP to have a healthcare provider diagnosis. In our LBP sample moving from ≥3 months to the RTF definition reduced the CLBP group size by 25% and resulted in a group that used more pain management options and reported worse health across all outcome measures. A pain duration definition offers ease of application. However, refinements to this definition (eg, RTF) can identify those who may be better intervention targets.
      Perspective: This article presents the definitions used for CLBP by researchers and individuals, and the impact of these definitions on pain management and health outcomes. This information may help researchers choose better study inclusion criteria and clinicians to better understand their patients’ beliefs about CLBP.

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      1. Agency for Healthcare Research and quality: Noninvasive nonpharmacological treatment for chronic pain: A systematic review. Vol AHRQ Pub. No. 18-EHC013-1-EF, agency for healthcare research and quality, Rockville, MD, 2018.

        • Campbell P
        • Foster NE
        • Thomas E
        • Dunn KM.
        Prognostic indicators of low back pain in primary care: Five-year prospective study.
        J Pain. 2013; 14: 873-883
        • Cedraschi C
        • Robert J
        • Goerg D
        • Perrin E
        • Fischer W
        • Vischer T.
        Is chronic non-specific low back pain chronic? Definitions of a problem and problems of a definition.
        Br J Gen Pract. 1999; 49: 358-362
        • Chandler J
        • Rosenzweig C
        • Moss AJ
        • Robinson J
        • Litman L.
        Online panels in social science research: Expanding sampling methods beyond Mechanical Turk.
        Behav Res Methods. 2019; 51: 2022-2038
        • Chou R
        • Shekelle P.
        Will this patient develop persistent disabling low back pain?.
        JAMA. 2010; 303: 1295-1302
        • Cruz EB
        • Canhão H
        • Fernandes R
        • Caeiro C
        • Branco JC
        • Rodrigues AM
        • Pimentel-Santos F
        • Gomes LA
        • Paiva S
        • Pinto I.
        Prognostic indicators for poor outcomes in low back pain patients consulted in primary care.
        PLoS One. 2020; 15e0229265
        • Deyo RA
        • Dworkin SF
        • Amtmann D
        • Andersson G
        • Borenstein D
        • Carragee E
        • Carrino J
        • Chou R
        • Cook K
        • DeLitto A.
        Report of the NIH Task Force on research standards for chronic low back pain.
        Pain Med. 2014; 15: 1249-1267
        • Fairbank JC
        • Pynsent PB.
        The Oswestry disability index.
        Spine. 2000; 25: 2940-2953
        • Ferreira ML
        • Machado G
        • Latimer J
        • Maher C
        • Ferreira PH
        • Smeets RJ.
        Factors defining care-seeking in low back pain–A meta-analysis of population based surveys.
        Eur J Pain. 2010; 14 (e741-747. e747): 747
        • George SZ
        • Fritz JM
        • Silfies SP
        • Schneider MJ
        • Beneciuk JM
        • Lentz TA
        • Gilliam JR
        • Hendren S
        • Norman KS
        • Beattie PF.
        Interventions for the management of acute and chronic low back pain: Revision 2021: Clinical practice guidelines linked to the international classification of functioning, disability and health from the academy of orthopaedic physical therapy of the American Physical Therapy Association.
        J Orthop Sports Phys Ther. 2021; 51: CPG1-CPG60
        • Grotle M
        • Brox JI
        • Vollestad NK.
        Concurrent comparison of responsiveness in pain and functional status measurements used for patients with low back pain.
        Spine. 2004; 29: E492-E501
        • Hill JC
        • Dunn KM
        • Lewis M
        • Mullis R
        • Main CJ
        • Foster NE
        • Hay EM.
        A primary care back pain screening tool: Identifying patient subgroups for initial treatment.
        Arthritis Care & Res: Off J Am Coll Rheumatol. 2008; 59: 632-641
        • Hoy D
        • Brooks P
        • Blyth F
        • Buchbinder R.
        The epidemiology of low back pain.
        Best Pract Res Clin Rheumatol. 2010; 24: 769-781
        • Hoy D
        • March L
        • Brooks P
        • Blyth F
        • Woolf A
        • Bain C
        • Williams G
        • Smith E
        • Vos T
        • Barendregt J.
        The global burden of low back pain: Estimates from the global burden of disease 2010 study.
        Ann Rheum Dis. 2014; 73: 968-974
        • Jess M-A
        • Ryan C
        • Hamilton S
        • Wellburn S
        • Atkinson G
        • Greenough C
        • Peat G
        • Coxon A
        • Fatoye F
        • Ferguson D
        Does duration of pain at baseline influence longer-term clinical outcomes of low back pain patients managed on an evidence-based pathway?.
        Spine. 2021; 46: 191-197
        • Kent PM
        • Keating JL.
        The epidemiology of low back pain in primary care.
        Chiropractic & osteopathy. 2005; 13: 1-7
        • Konstantinou K
        • Dunn KM
        • Ogollah R
        • Vogel S
        • Hay EM.
        Characteristics of patients with low back and leg pain seeking treatment in primary care: Baseline results from the ATLAS cohort study.
        BMC musculoskeletal disorders. 2015; 16: 1-11
        • Krebs EE
        • Lorenz KA
        • Bair MJ
        • Damush TM
        • Wu J
        • Sutherland JM
        • Asch SM
        • Kroenke K.
        Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference.
        J Gen Intern Med. 2009; 24: 733-738
        • Krippendorff K
        Content Analysis: An Introduction to its Methodology.
        Sage Publications, Beverly Hills1980
      2. Lucas JW, Connor EM, Back Bose J: Lower Limb, and Upper Limb Pain Among US Adults, 2019, National Center for Health Statistics, Hyattsville, MD, 2021.

        • Maher C
        • Underwood M
        • Buchbinder R.
        Non-specific low back pain.
        The Lancet. 2017; 389: 736-747
        • Manchikanti L
        • Singh V
        • Falco FJ
        • Benyamin RM
        • Hirsch JA.
        Epidemiology of low back pain in adults.
        Neuromodulation: Technol at the Neural Interface. 2014; 17: 3-10
        • Mehling WE
        • Gopisetty V
        • Bartmess-LeVasseur E
        • Acree M
        • Pressman A
        • Goldberg H
        • Hecht FM
        • Carey T
        • Avins AL.
        The prognosis of acute low back pain in primary care in the US A 2-year prospective cohort study.
        Spine. 2012; 37: 678
        • Middleton P
        • Pollard H.
        Are chronic low back pain outcomes improved with co-management of concurrent depression?.
        Chiropractic & Osteopathy. 2005; 13: 1-7
        • Murad MH
        • Asi N
        • Alsawas M
        • Alahdab F.
        New evidence pyramid.
        BMJ Evidence-Based Med. 2016; 21: 125-127
      3. National Center for Injury Prevention and Control: Acute Low Back Pain. Available at: Accessed March 15, 2022

        • Nicholas M
        • Vlaeyen JW
        • Rief W
        • Barke A
        • Aziz Q
        • Benoliel R
        • Cohen M
        • Evers S
        • Giamberardino MA
        • Goebel A.
        The IASP classification of chronic pain for ICD-11: Chronic primary pain.
        Pain. 2019; 160: 28-37
      4. Nye J: ICD-11 revision addresses biopsychosocial definitions of chronic pain. Available at:∼:text=%2D10)%20classifications.-,Clinicians%20should%20be%20aware%20that%20not%20all%20ICD%2D11%20diagnoses,02%20Chronic%20primary%20musculoskeletal%20pain. Accessed May 18, 2022

        • Pons T
        • Shipton E
        • Mulder R.
        The relationship between beliefs about pain and functioning with rheumatologic conditions.
        Rehabil Res Pract. 2012; 9: 2012
        • Qaseem A
        • Wilt TJ
        • McLean RM
        • Forciea MA.
        Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians.
        Ann Intern Med. 2017; 166: 514-530
        • Qureshi N
        • Edelen M
        • Hilton L
        • Rodriquez A
        • Hays RD
        • Herman PM.
        Comparison of data collected using Amazon's Mechanical Turk to national surveys.
        Am J Health Behav. 2022; ([In press])
        • Roland M
        • Morris R.
        A study of the natural history of back pain: part I: Development of a reliable and sensitive measure of disability in low-back pain.
        Spine. 1983; 8: 141-144
        • Setchell J
        • Costa N
        • Ferreira M
        • Makovey J
        • Nielsen M
        • Hodges PW.
        Individuals’ explanations for their persistent or recurrent low back pain: A cross-sectional survey.
        BMC Musculoskeletal Disorders. 2017; 18: 1-9
        • Smeets RJ
        • Vlaeyen JW
        • Kester AD
        • Knottnerus JA.
        Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain.
        J Pain. 2006; 7: 261-271
        • Stevans JM
        • Delitto A
        • Khoja SS
        • Patterson CG
        • Smith CN
        • Schneider MJ
        • Freburger JK
        • Greco CM
        • Freel JA
        • Sowa GA.
        Risk factors associated with transition from acute to chronic low back pain in US patients seeking primary care.
        JAMA Network Open. 2021; 4e2037371
      5. Stroke NIoNDa: Back Pain Fact Sheet. Available at: Accessed March 15, 2022

        • Tricco AC
        • Lillie E
        • Zarin W
        • O'Brien KK
        • Colquhoun H
        • Levac D
        • Moher D
        • Peters MD
        • Horsley T
        • Weeks L
        PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation.
        Ann Intern Med. 2018; 169: 467-473
        • Von Korff M
        • DeBar LL
        • Krebs EE
        • Kerns RD
        • Deyo RA
        • Keefe FJ.
        Graded chronic pain scale revised: Mild, bothersome, and high impact chronic pain.
        Pain. 2020; 161: 651
        • Von Korff M
        • Miglioretti DL.
        A prognostic approach to defining chronic pain.
        Pain. 2005; 117: 304-313
        • Von Korff M
        • Ormel J
        • Keefe FJ
        • Dworkin SF.
        Grading the severity of chronic pain.
        Pain. 1992; 50: 133-149
        • Walters K
        • Christakis DA
        • Wright DR.
        Are mechanical turk worker samples representative of health status and health behaviors in the US?.
        PLoS One. 2018; 13e0198835
        • Wasiak RP
        • Pransky GMDM
        • Verma SMS
        • Webster BBPAC.
        Recurrence of low back pain: Definition-sensitivity analysis using administrative data.
        Spine. 2003; 28: 2283-2291
      6. World Health Organization: International Statistical Classification of Diseases and Related Health Problems (ICD). Available at: Accessed May 18, 2022

        • Wu A
        • March L
        • Zheng X
        • Huang J
        • Wang X
        • Zhao J
        • Blyth FM
        • Smith E
        • Buchbinder R
        • Hoy D.
        Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the global burden of disease study 2017.
        Ann Translational Med. 2020; 8: 299
        • Zhang B
        • Gearhart S.
        Collecting online survey data: A comparison of data quality among a commercial panel & MTurk.
        Surv Pract. 2020; 13: 1-10