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The Impact of Low Back-related Leg Pain on Outcomes as Compared With Low Back Pain Alone: A Systematic Review of the Literature

Konstantinou, Kika PhD; Hider, Samantha L. PhD; Jordan, Joanne L. MSc, MA; Lewis, Martyn PhD; Dunn, Kate M. PhD; Hay, Elaine M. MD

The Clinical Journal of Pain: July 2013 - Volume 29 - Issue 7 - p 644–654
doi: 10.1097/AJP.0b013e31826f9a52
Review Articles

Objectives: Low back pain (LBP) with leg pain, especially with findings of nerve root involvement, is considered as a poor prognostic indicator although it seems to have a favorable natural resolution. It is unclear whether patients with LBP and leg pain are at the more severe end of the spectrum as compared with patients with LBP alone or whether they are a distinct subgroup that would perhaps benefit from early identification of the condition and more targeted interventions. The purpose of this study was to investigate the impact of LBP-related leg pain on outcomes and use of health resources as compared with patients with LBP alone.

Methods: Systematic review of studies reporting separate outcomes of patients with LBP and LBP with leg pain and synthesis of available evidence. Literature search of all English language peer-reviewed publications was conducted using MEDLINE, EMBASE, and CINAHL for the years 1994 to 2010.

Results: Of the papers retrieved, 9 were included in the review. The heterogeneity of studies allowed only narrative analysis of findings. All studies reported worse health outcomes and increased use of health care with radiation of leg pain distally and with neurological findings, with the exception of psychological outcomes.

Discussion: LBP with pain radiating to the leg appears to be associated with increased pain, disability, poor quality of life, and increased use of health resources compared with LBP alone. These findings argue for early identification of these cases by health care professionals and pursuing effective treatments.

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Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK

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The authors declare no conflict of interest. This paper presents independent research commissioned by the National Institute for Health Research (NIHR, UK) under its Programme Grants for Applied Research funding scheme (RP-PG-0707-10131). The views expressed in this paper are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Reprints: Kika Konstantinou, PhD, Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire ST5 5BG, UK (e-mail:

Received June 23, 2011

Accepted August 16, 2012

© 2013 by Lippincott Williams & Wilkins