Characterizing the Course of Low Back Pain: A Latent Class Analysis

Dunn, Kate M.; Jordan, Kelvin P.; Croft, Peter

doi:10.1093/aje/kwj100

Cited by 290 publications

(291 citation statements)

References 29 publications

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“…Our definitions of the outcomes based on the number of days with low back pain in a given time period correspond well to the definitions of low back pain recommended recently, with low back pain Ͼ30 days in the past 12 months classified as chronic low back pain (24). The cutoff value between no or minor and moderate pain was set at 7 days, because previous studies have shown that those with pain of a shorter duration recover quickly (26). Moreover, distinguishing nonspecific and radiating low back pain will enable us to capture entities with different risk factors (16,17) and clinical course (27).…”

Section: Discussionmentioning

confidence: 99%

Incidence of nonspecific and radiating low back pain: followup of 24–39‐year‐old adults of the Young Finns Study

Shiri

Solovieva

Husgafvel‐Pursiainen

et al. 2010

Arthritis Care & Research

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Objective. The full panorama of the types and severity of low back pain during the life course is poorly known. We studied the incidence and severity of nonspecific and radiating low back pain based on a recent followup on a representative sample of the Finnish general population. Methods. As part of the ongoing Young Finns Study, participants ages 24 -39 years who were free from low back pain at baseline in 2001 were included (n ‫؍‬ 1,224). We estimated the incidence of nonspecific and radiating low back pain in 2007.Results. The incidence of moderate (8 -30 days duration in the past 12 months) nonspecific low back pain was 13.2%, and that of radiating low back pain was 8.6%. The rates did not differ between men and women. The incidence of major (>30 days in the past 12 months) nonspecific low back pain was 7.8%, and that of radiating low back pain was 3.4%. The incidence of major nonspecific low back pain was higher in women than in men (P ‫؍‬ 0.02). Moderate as well as major nonspecific low back pain declined with age, whereas major radiating low back pain increased with age. Conclusion. Our findings indicate that low back pain is a common condition in adults already in their 30s. It becomes more severe around the age of 40 years, showing different development of nonspecific and radiating low back pain. We recommend monitoring low back health in health surveillance, starting early and differentiating between nonspecific and radiating pain.

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Section: Discussionmentioning

confidence: 99%

Incidence of nonspecific and radiating low back pain: followup of 24–39‐year‐old adults of the Young Finns Study

Shiri

Solovieva

Husgafvel‐Pursiainen

et al. 2010

Arthritis Care & Research

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“…Pain outcomes are highly variable over time and between individuals (6,10,11,18,35). A prognostic approach discards the notion that "chronic" means unlikely to change.…”

Section: Discussionmentioning

confidence: 99%

Chronic pain reconsidered

Korff¹,

Dunn²

2008

Pain

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Chronic pain has been traditionally defined by pain duration, but this approach has limited empirical support; and does not account for chronic pain's multidimensionality. This study compared durationbased and prospective approaches to defining chronic pain in terms of their ability to predict future pain course and outcomes for primary care patients with three common pain conditions: back pain (n = 971), headache (n = 1078), or orofacial pain (n = 455). At baseline, their chronic pain was classified retrospectively based on Pain Days in the prior six months and prospectively with a prognostic Risk Score identifying patients with "possible" or "probable" chronic pain. The 0-28 Risk Score was based on pain intensity, pain-related activity limitations, depressive symptoms, number of pain sites, and Pain Days. Pain and behavioral outcomes were assessed at six-month follow-up, and long-term opioid use was assessed two to five years after baseline. Risk Score consistently predicted clinically significant pain at six months better than did Pain Days alone (Area under the Curve of 0.74-0.78 for Risk Score vs. 0.63-0.73 for Pain Days). Risk Score was a stronger predictor of future SF-36 Physical Function, pain-related worry, unemployment, and long-term opioid use than Pain Days alone. Thus, for these three common pain conditions, a prognostic Risk Score had better predictive validity for pain outcomes than did pain duration alone. However, chronic pain appears to be a continuum rather than a distinct class, because long-term pain outcomes are highly variable and inherently uncertain.

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“…The classification used in the present study is focused on biomedical factors although several aspects should be considered when developing a complete classification system. Subgroups may be based on pathoanatomical factors, clinical characteristics, and psychosocial factors or on differential prognosis and differential response to treatment (Long et al 2004;McCarthy et al 2004;Dunn et al 2006). The factors might be mutually exclusive or complementary.…”

Section: Discussionmentioning

confidence: 99%