title: Recurrence of Pain After Usual Nonoperative Care for Symptomatic Lumbar Disk Herniation: Analysis of Data From the Spine Patient Outcomes Research Trial.
abstract: To determine risks and predictors of recurrent leg and low back pain (LBP) after unstructured, usual nonoperative care for subacute/chronic symptomatic lumbar disk herniation (LDH).
  
  
  
  Secondary analysis of data from a concurrent randomized trial and observational cohort study.
  
  
  
  Thirteen outpatient spine practices.
  
  
  
  A total of 199 participants with resolution of leg pain and 142 participants with resolution of LBP from among 478 participants receiving usual nonoperative care for symptomatic LDH.
  
  
  
  Potential predictors of recurrence included time to initial symptom resolution, sociodemographics, clinical characteristics, work-related factors, imaging-detected herniation characteristics, and baseline pain bothersomeness.
  
  
  
  Leg pain and LBP bothersomeness were assessed by the use of a 0-6 numerical scale at up to 4 years of follow-up. For individuals with initial resolution of leg pain, we defined recurrent leg pain as having leg pain, receiving lumbar epidural steroid injections, or undergoing lumbar surgery subsequent to initial leg pain resolution. We calculated cumulative risks of recurrence by using Kaplan-Meier survival plots and examined predictors of recurrence using Cox proportional hazards models. We used similar definitions for LBP recurrence.
  
  
  
  One- and 3-year cumulative recurrence risks were 23% and 51% for leg pain, and 28% and 70% for LBP, respectively. Early leg pain resolution did not predict future leg pain recurrence. Complete leg pain resolution (adjusted hazard ratio [aHR] 0.47, 95% confidence interval [CI] 0.31-0.72) and posterolateral herniation location (aHR 0.61; 95% CI 0.39-0.97) predicted a lower risk of leg pain recurrence, and joint problems (aHR 1.89; 95% CI 1.16-3.05) and smoking (aHR 1.81; 95% CI 1.07-3.05) predicted a greater risk of leg pain recurrence. For participants with complete initial resolution of pain, recurrence risks at 1 and 3 years were 16% and 41% for leg pain and 24% and 59% for LBP, respectively.
  
  
  
  Recurrence of pain is common after unstructured, usual nonsurgical care for LDH. These risk estimates depend on the specific definitions applied, and the predictors identified require replication in future studies.
authors.affiliation: Seattle Epidemiologic Research and Information Center (ERIC) and Division of Rehabilitation Care Services, VA Puget Sound Health Care System, S-152-ERIC, 1660 S. Columbian Way, Seattle WA; and Department of Rehabilitation Medicine, University of Washington, Seattle, WA(∗). Electronic address: pradeep.suri@va.gov.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Suri
authors.affiliation: Department of Orthopaedics, Geisel School of Medicine, The Dartmouth-Hitchcock Medical Center, Hanover/Lebanon, NH(†).
authors.forename: Adam M
authors.initials: AM
authors.lastname: Pearson
authors.affiliation: Department of Medicine, Geisel School of Medicine, The Dartmouth-Hitchcock Medical Center, Hanover/Lebanon, NH(‡).
authors.forename: Emily A
authors.initials: EA
authors.lastname: Scherer
authors.affiliation: Department of Orthopaedics, Geisel School of Medicine, The Dartmouth-Hitchcock Medical Center, Hanover/Lebanon, NH(§).
authors.forename: Wenyan
authors.initials: W
authors.lastname: Zhao
authors.affiliation: Department of Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, The Dartmouth-Hitchcock Medical Center, Hanover/Lebanon, NH(‖).
authors.forename: Jon D
authors.initials: JD
authors.lastname: Lurie
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, The Dartmouth-Hitchcock Medical Center, Hanover/Lebanon, NH(¶).
authors.forename: Tamara S
authors.initials: TS
authors.lastname: Morgan
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, The Dartmouth-Hitchcock Medical Center, Hanover/Lebanon, NH(#).
authors.forename: James N
authors.initials: JN
authors.lastname: Weinstein
mesh_terms: D006801:Humans; D015331:Cohort Studies; D007405:Intervertebral Disc Displacement; D017116:Low Back Pain; D008159:Lumbar Vertebrae; D012008:Recurrence; D016896:Treatment Outcome; D000094422:Secondary Data Analysis