Evaluation and outcome of low-back pain of unknown etiology

Between January 1980 and January 1985, 5,362 patients with low-back pain were evaluated prospectively using a standard approach. The majority improved with routine therapy or could be placed in a definitive diagnostic group. One hundred and nine (2%), however, failed to improve or could not be assigned a specific diagnosis. These patients, defined as having chronic low-back pain of unknown etiology, were referred to a rheumatologist for evaluation. The average time to referral was 6 months. A specific diagnosis was obtained for 14 of the 109 patients. The remaining 95 were placed on new treatment plans, which included detoxification, a change of physicians, and arbitrary changes in therapy. The results indicated that approximately 75% of the group had 50% or greater reduction of pain, and half of the workers' compensation patients returned to some form of employment (although perhaps only intermittent).