Pain in low-back pain. Problems in measuring outcomes in musculoskeletal disorders.

Abstract

One of the crucial issues of clinical research in musculo-skeletal disorders is outcome measurement. This has been the central question of the Outcomes Movement, and has occupied many researchers in all musculo-skeletal specialties: which outcomes should we measure? Rheumatologists, Rehabilitation Physicians, Traumatologists and Orthopeadic Surgeons have tried to answer this question from different points of view, very often isolated from each other and without interpolating efforts. One good example of a multidisciplinary subject is low-back pain (LBP). It is not a disease, but a symptom, and a common experience in the life of almost every human being, as well as a growing cause of direct and indirect costs for the social systems in many industrialized countries. From a medical point of view, it is a multifaceted syndrome: causes and clinical presentations vary widely. Psychological, social and economic status of the patient seem to play a role in the history of LBP, and many different specialists and disciplines are involved in the treatment. To compare results, we would need a simple and standardised outcome measure that accounts for different clinical presentations, interactions, and therapeutic approaches (Deyo et al. 1998). Unfortunately, as in most musculoskeletal disorders, very rarely simple dichotomous outcomes can be used in evaluating results of treatment alternatives for LBP. Patients rarely are totally ill or completely disease-free, but very often  uctuate between better or worse health status. Pain in low-back pain