Episodic low back pain - characterising symptom flares

Background: The presentation of nonspecific low back pain is highly heterogeneous and recent studies have identified numerous patient trajectories, ranging from stable, mild or high level pain with little symptom variation over time; to fluctuating trajectories, where patients experience varying levels of pain or multiple discrete pain episodes over its course. However, most studies record symptom data with insufficient temporal resolution to capture information about short-term variation in amplitude and typical patterns of pain fluctuation are still unclear. Symptom fluctuations or flares, loosely defined as a period when pain is more severe than usual, have been well characterised in other musculoskeletal conditions (e.g. osteoarthritis and rheumatoid arthritis). However, although commonly reported in low back pain, there is still a paucity of evidence and lack of consensus relating to low back pain flares. The presentation of nonspecific back pain is highly heterogeneous and recent studies have identified numerous patient trajectories, ranging from stable, mild or high level pain with little symptom variation over time; to fluctuating trajectories, where patients experience varying levels of pain or multiple discrete pain episodes over its course. However, most studies record symptom data with insufficient temporal resolution to capture information about short-term variation in amplitude and typical patterns of pain fluctuation are still unclear. Symptom fluctuations or flares, loosely defined as a period when pain is more severe than usual, have been well characterised in other musculoskeletal conditions (e.g. osteoarthritis and rheumatoid arthritis). However, although commonly reported in back pain, there is still a paucity of evidence and lack of consensus relating to back pain flares or what changes in pain or other features need to be considered. Objectives: 1. To improve understanding of the episodic nature of back pain by: a. Characterising symptom flares in back pain; b. Describing the different symptom trajectories in back pain; 2. To initiate discussions on a consensus-based definition of flares in low back pain; 3. To identify factors and activities that could potentially trigger back pain flares; 4. To identify the impact of increasing knowledge of flares to patients, clinicians and researchers. Target audience: Researchers and clinicians interested in better understanding the episodic nature of low back pain. How the workshop will be conductedL A series of short presentations will provide data and evidence for a group discussion (45 minutes). These presentations will last 5-10 minutes each and include: a. How are back pain flares defined from a patient's perspective? A) How are back pain flares defined from a researcher's perspective and how is that different to other conditions? (B). How are flares different to a recurrent episode? (C) What is the impact of back pain flares from the patient's perspective? (D) What are the different patient trajectories for back pain and how is the episodic trajectory characterised? (E) Which patients are more likely to develop back pain flares? A guided group discussion will be introduced to address aims 2-4, i.e. work towards a consensus on the definition of flares and identify potential triggers for a back pain flare (45 minutes). Some of the topics which will be discussed include: (A) Should flares be defined in terms of pain, disability, care-seeking? (B) Should flares be defined as a minimum symptom increase? (C) Do we need to identify/address flares in back pain? D(D) Are the triggers for flares likely to be different from those for recurrence? (E) Do flares differ across conditions? Desired outcomes: An informed discussion on the impact of back pain flares and the importance of better defining and characterising flares in this field.