Background: The natural history of low back pain remains ill defined. This study has provided a unique opportunity to follow a community based cohort of people over a seven year period from 1994 to 2000.

Methodology: The respondents to the 1994 survey were the panel of adults used in this survey. This sample of 3,184 was validated against the current electoral register resulting in a sample size of 1,918. Valid responses totalled 957. Questions were designed to elicit data in an identical manner to the previous surveys.

Results: Periodicity data indicated that the majority of people with chronic persistent pain had recurrent acute episodes rather than one continuous episode. Significant predictors of persistent low back pain included higher scores on the Zung Depression Index, the Roland and Morris Disability Questionnaire, visual analogue pain scales and the Back Beliefs Questionnaire. People who developed low back pain in 2000 but didn’t report low back pain in 1994 or 1997, were distinguishable from those who did not develop low back pain by the number of disabilities reported in 1994.

Conclusions: The natural history of low back pain prevalence in this cohort of people does not entirely support the view that back pain starts as a series of acute episodes when younger which gradually merge to become chronic as the person becomes older. Many people will continue to experience intermittent acute episodes of low back pain well in to their sixties. Pre-morbid disability may result from pain in areas other than the low back, probably reflecting an increased reporting of pain generally. Some of this group will ultimately include people with chronic widespread pain. Adverse coping strategies may influence the persistence of pain in this group.