Defining The Term ‘Flare’ in Low Back Pain (LBP)

It turns out, there isn’t much of a consensus when it comes to the definition of Low Back Pain Flare. A study 1 from The Journal of Pain set out to change that to possibly help LBP patients, clinicians, and researchers around the globe.

Why Focus on LBP Flare?

Low back pain tends to vary over time. Numerous terms are used by medical professionals and researchers to describe the fluctuations. The term “Flare” is used for describing symptom fluctuation. However, the definition of the said term isn’t the same for everyone.

With LBP being a common musculoskeletal condition around the globe, the current study deemed it necessary to bring consensus to the term “Flare” or “Flare up” with regards to LBP. According to research, most people tend to experience LBP at least once. For many others, such a condition lasts throughout their lifespan (with fluctuating trajectories).

The Study

This was a mixed-method study. It consisted of four steps.

  1. Deriving the definition of LBP flare from the perspectives of individuals with LBP.
  2. Using the perspectives of experts.
  3. Undergoing a Delphi process with experts to polish the definition of LBP flare and reach an expert consensus.
  4. Applying qualitative testing to the definition with individuals with LBP.

Flare Low Back Pain

For the first step, five authors met on 3 different occasions for considering the perspective of individuals with LBP. They discussed the terminology to cover the features that separate other symptom fluctuations from flare. The initial definition was refined (involving consultation from an expert consumer writer).

For the second step, a workshop was held at the International Forum for Back and Neck Pain Research in Primary Care (Buxton UK, June 2016) with a group of 19 experts in LBP.

In the third step, a two-round Delphi process was conducted. The goal was to gather feedback from a diverse group of international experts, and to present a definition (from the collected feedback) to the participants for evaluating acceptability.

Take note, the Delphi process was implemented online via a web-based system (Google Drive).

A total of sixty-two experts were invited to participate. This included 19 participants of the Step 2 workshop, 19 members of the organizing committee of the International Forum for Back and Neck Pain Research in Primary Care, and a total of 24 other individuals with expertise in LBP flare or related conditions (or having international recognition in the field of musculoskeletal research).

Testing, during the fourth step, involved scenarios and follow-up questions. The participants were invited via social media, local community, and health centers. One of the eligibility criteria was the individual’s self-identification of previous or current LBP.

Defining The Term ‘Flare’ in Low Back Pain LBP

What did the Results Show?

The results of the study displayed how flare (connected to LBP) is multifaceted. The findings aligned with the research team’s expectations about how not every individual with LBP flare will experience all of the factors mentioned in the definition. However, the definition will be broad enough for many to relate to.

Where There Any Limitations?

The research team does share the current study might not have been able to accommodate every expert opinion because of the utilized selection criteria. Furthermore, the sample was biased toward people with long-term recurring or persistent/chronic symptoms.

What’s the Take-Away?

LBP flare is multifaceted and thus, needs an appropriate definition. The current study was able to propose a definition that might work well in a clinical or research context. The said definition is likely to have a beneficial use in epidemiologic studies as well as have clinical implications in terms of measuring treatment efficacy.

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