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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald

CiteScore 2017: 0.84

SCImago Journal Rank (SJR) 2017: 0.401
Source Normalized Impact per Paper (SNIP) 2017: 0.452

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Volume 17, Issue 1


What constitutes back pain flare? A cross sectional survey of individuals with low back pain

Jenny Setchell
  • Corresponding author
  • The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Nathalia Costa
  • The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
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  • De Gruyter OnlineGoogle Scholar
/ Manuela Ferreira
  • The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
  • Institute of Bone and Joint Research/The Kolling Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Joanna Makovey
  • The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
  • Institute of Bone and Joint Research/The Kolling Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
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  • De Gruyter OnlineGoogle Scholar
/ Mandy Nielsen
  • The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
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  • De Gruyter OnlineGoogle Scholar
/ Paul W. Hodges
  • The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2017-10-01 | DOI: https://doi.org/10.1016/j.sjpain.2017.08.003


Background and purpose

Low back pain (LBP) is a lifelong problem for many. In acute episodes, or as a persistent condition, LBP is fluctuating in nature, with pain and other features of the condition varying in intensity and duration over time. Symptom flares (also known as flare ups) contribute to this variation and can have a great impact on the lives of those who have LBP. An important goal of treatments for, and research on, LBP is arguably to decrease symptom flare in both frequency and severity. However, this goal is problematic with little research, and no consensus, on how to define LBP flare. In particular, patients’ understandings of LBP flare have received limited attention in the literature. To appropriately address this issue, we sought to understand how flares are conceptualized by individuals with LBP.


We used an inductive, predominantly qualitative methodology, conducting an online survey with 130 individuals who self-reported experiencing LBP. The survey investigated participants’ views on LBP flare including its meaning, features and symptoms, and whether ‘flare’ and ‘pain increase’ were synonymous. Qualitative analysis of responses involved thematic and content analysis with descriptive statistics used for the quantitative component.


Our data analysis found that participants identified many aspects of a flare to be important. Qualitative analyses highlighted a number of themes including that LBP flare was conceptualized as: (1) on increase in pain and other uncomfortable sensations such as paraesthesia or muscle tension, (2) an increase in the area, quality and/or duration of symptoms, (3) a reduction in physical, cognitive and/or social functioning, and (4) negative psychological and/or emotional factors. Flare was also discussed as a change that was difficult to settle. When participants considered whether ‘flare’ and ‘pain increase’ were synonymous, responses were evenly divided between ‘no’ (47%) and ‘yes’ (46%) with remaining participants ‘unsure’.


The key finding was that many people with LBP do not consider their condition to be flared simply on the basis of a pain increase. In general, other features were required to also change. Results highlighted that a narrow focus on pain is unlikely to differentiate minor pain events from a flare. these findings are important as they contrast with most commonly used definitions of a flare that focus predominantly on pain increase.


Our findings have implications for understanding the trajectory of LBP over time. Understandings derived from perspectives of individuals with LBP highlight that defining flare in LBP is complex. In order to provide person-centred care, individual context and experiences should be taken into account. Therefore, understandings of LBP flare require consideration of factors beyond simply an increase in pain. A comprehensive, person-centred understanding of flare that includes a number of features beyond simply an increase in pain intensity is likely to be useful to better identify flares in research settings, assisting endeavours to understand and reduce LBP. Similarly, in clinical settings a nuanced conceptualisation of flare is likely to help health professionals communicate understandings of flare when working with individuals to manage their LBP.

Keywords: Pain flare; Low back pain; Patient perspectives; Qualitative research; Person-centred


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About the article

School of Health and Rehabilitation Sciences, The University of Queensland, QLD 4072, Australia

Received: 2017-05-10

Revised: 2017-07-27

Accepted: 2017-08-01

Published Online: 2017-10-01

Published in Print: 2017-10-01

Ethical issues: Institutional approval was sought and gained for this project. Informed consent was required and participants gave informed consent. Data was handled within institutional guidelines to ensure anonymity of participants in data storage and reporting. As the research was not a clinical trial it was not registered.

Conflicts of interest: The authors state that there are no conflicts of interest to declare.

Citation Information: Scandinavian Journal of Pain, Volume 17, Issue 1, Pages 294–301, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2017.08.003.

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