Pain location matters: the impact of leg pain on health care use, work disability and quality of life in patients with low back pain

Abstract

Purpose In low back pain (LBP) patients, those with radiating leg pain or sciatica have poorer pain and disability outcomes. Few studies have assessed the effect of leg pain on health care use and quality of life. Methods Prospective cohort study of 1,581 UK LBP primary care consulters. Back pain, employment, health care utilisation, and quality of life (EQ-5D) data were collected at baseline, 6 and 12 months. At baseline, patients were classified as reporting (1) LBP only, (2) LBP and leg pain above the knee only (LBP ? AK) or (3) LBP and leg pain extending below the knee (LBP ? BK). Results Self-reported leg pain was common; at baseline 645 (41 %) reported LBP only, 392 (25 %) reported LBP ? AK and 544 (34 %) reported LBP ? BK. Patients with LBP ? BK, compared to those with LBP only, were significantly more likely to be unemployed, take time off work, consult their family doctor, receive physical therapy, or be referred to other health care practitioners. There were statistically significant decrements in EQ-5D scores for LBP ? AK compared to LBP only, and for LBP ? BK compared to LBP ? AK (p B 0.05 for all comparisons).Conclusions Patients with self-reported leg pain below the knee utilise more health care are more likely to be unemployed and have poorer quality of life than those with LBP only 12 months following primary care consultation. The presence of leg pain warrants early identification in primary care to explore if targeted interventions can reduce the impact and consequences of leg pain.

Association Between Widespread Pain Scores and Functional Impairment and Health-Related Quality of Life in Clinical Samples of Children

“…Moreover, recent studies examining response to surgical treatment have shown that widespread pain is associated with greater opioid requirements 4,11 and persistence of pain after surgery 5 , even with widespread pain scores well below the threshold for a diagnosis of fibromyalgia. Another aspect of spatial distribution of pain found to influence health and function in adults is the specific pattern of pain sites 2,8,10 . For example, axial pain 2 and knee pain 8,10 were associated with greater disability in several clinical samples of adults.…”

“…Another aspect of spatial distribution of pain found to influence health and function in adults is the specific pattern of pain sites 2,8,10 . For example, axial pain 2 and knee pain 8,10 were associated with greater disability in several clinical samples of adults.…”

Radiating low back pain in general practice: Incidence, prevalence, diagnosis, and long-term clinical course of illness

“…Most descriptive research on the subject is performed in hospital settings with a short-term follow-up. Incidence and prevalence rates vary widely between studies because populations and definitions vary [ 6 , 7 ]. Little is known about the long-term clinical course of illness of radiating low back pain in general practice or about the treatment strategies employed by GPs.…”

Impacts of persistent general and site‐specific pain on activities of daily living and physical performance: A prospective analysis of the English Longitudinal Study of Ageing

“…Multiple‐site pain requires more complex and specialized treatment than pain from a single site. Self‐reported musculoskeletal pain is known to be a predictor of independence, unmet long‐term needs for healthcare and overall quality of life . The present findings highlight the value of monitoring and management of both general and specific pain in order to promote sustained independence at older ages.…”