Are prognostic indicators for poor outcome different for acute and chronic low back pain consulters in primary care?

Abstract

Few studies have investigated whether prognostic indicators, which contribute to the transition from acute to chronic low back pain (LBP), are also those which contribute to continuing persistence of chronic LBP. We compared the contribution of physical, psychological and social indicators to predicting disability after one year between consulters with LBP of less than 3 months duration and more than 3 months duration. Data from two large prospective cohort studies of consecutive patients consulting with LBP in general practices were merged, providing complete data for 258 cases with acute/subacute LBP and 668 cases with chronic LBP at 12 months follow-up. There were significant differences between the two LBP groups in baseline characteristics and clinical course of disability, assessed by Roland Morris Disability Questionnaire, during the year of follow-up. Adjusted associations between potential prognostic indicators and disability at 12months were carried out in the two LBP subgroups. The final multivariable regression models showed that being non-employed, having widespread pain, a high level of Chronic Pain Grade, and catastrophising were the strongest prognostic indicators for disability at 12 months in both LBP groups. Fear of pain was significantly associated with disability in chronic LBP. Importantly, beyond baseline disability, the effect size of the other prognostic indicators for poor outcome was rather low. These findings must continue to challenge researchers to identify useful early predictors of outcome in persons with disabling back pain, as screening and targeted treatment approaches are dependent upon prognostic indicators with clinical significance.

The predictive ability of the STarT Back Screening Tool in a Danish secondary care setting

“…Previous studies have shown that both influence outcome and return to work [26,27], but our findings indicate that, in this context, neither exerted an influence that could explain the differences between care settings in the SBT predictive ability.…”

Chronic Pain and DepressionAmong Primary Care Patients Treated with Buprenorphine

“…We divided our sample into three clinically relevant groups-those with no chronic pain, those with mild chronic pain, and those with moderate-severe chronic pain-as more severe chronic pain has a greater impact on quality of life in general population samples. [41][42][43] We hypothesized that there would be an association between more severe chronic pain and: 1) depression and increased use of antidepressant medication and counseling; 2) increased use of non-opioid pain medications; and 3) use of a substance (marijuana, alcohol or cocaine) to manage pain.…”

Prognosis of chronic low back pain in patients presenting to a private community-based group exercise program

“…Van Tulder et al [19] reported only small improvements in pain intensity and disability after 12 months (14.2 and 14.7 %, respectively). Grotle and colleagues [5], found only moderate changes in disability after 1 year (25 % reduction) for people with chronic LBP. When comparing the prognosis of our study participants to previous literature, it is important to realize we aimed to recruit a cohort lacking many of the previously reported adverse prognostic factors and who were receiving recommended care.…”

“…The final model consisted of two factors for pain (duration of the current episode and pain intensity at baseline) and three for disability (paid job, episode duration and disability), these factors explained 10 and 28 %, respectively, of the variance. Grotle et al [5], found five prognostic factors associated with 12-month disability in people with chronic LBP (being not employed widespread pain, chronic pain grade, fear of pain and catastrophizing), representing 52.7 % of variance. However, they note that beyond baseline disability the effect size for most predictors is relatively low.…”

“…Previous studies have identified factors associated with prognosis in chronic LBP [3][4][5][6]; however, the lack of quality studies means prognostic factors for chronic LBP remain unclear [7]. A large Australian cohort study [8] found previous sick leave due to LBP, high disability levels or high pain intensity at onset of chronicity, low levels of education, greater perceived risk of persistent pain, and being born outside Australia (immigrants) were associated with delayed recovery.…”