What do we know about flares in spinal and pelvic girdle pain? A scoping review

Flares in spinal and pelvic girdle pain, such as low back pain, can substantially impact quality of life; however, the understanding of definitions, assessment approaches, and associated factors remains limited. This scoping review mapped the literature on flare definitions, measurement tools, and reported risk factors in adults with spinal and pelvic girdle pain. We systematically searched five major databases (MEDLINE, EMBASE, CENTRAL, Web of Science, and CINAHL) to identify studies reporting on flares in spinal and pelvic girdle pain. Key data were extracted and synthesized thematically to map the current evidence and identify gaps. Among the 9,880 articles screened, 16 studies satisfied the inclusion criteria, all focusing exclusively on low back pain. Although definitions of flares had shifted from pain-centered models to multidimensional frameworks incorporating functional and emotional impacts, consensus on specific domains remains lacking. Assessment tools, which primarily included numerical rating scales and single-item self-reports, were identified, but none had psychometric validation. Physical activity, sleep, and psychological factors were identified risk factors for flares; however, the available evidence was limited and inconsistent, with most studies having a high risk of bias and focusing on a narrow range of factors. This review highlights significant gaps in the understanding and assessment of flares in spinal and pelvic girdle pain. Future research should focus on establishing a consensus on flare domains, developing validated assessment tools, and conducting rigorous studies to identify a broader range of risk factors across spinal and pelvic girdle pain.