Pain One Week After an Emergency Department Visit for Acute Low Back Pain Is Associated With Poor Three‐month Outcomes

Friedman, Benjamin W.; Conway, John; Campbell, Caron; Bijur, Polly E.; Gallagher, E. John

doi:10.1111/acem.13453

Cited by 18 publications

(22 citation statements)

References 16 publications

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“…1 Approximately 40% of patients presenting to the ED with acute LBP report pain-related functional impairment 3 months later. 2,3 These patients are at risk of developing chronic pain, which is often a highly debilitating condition. 4 As a result, investigators have sought to identify risk factors for the development of chronic back pain.…”

Section: Introductionmentioning

confidence: 99%

Depression and Functional Outcomes in Patients Presenting to the Emergency Department With Low Back Pain

Ring

Peskoe

Zhao

et al. 2020

Academic Emergency Medicine

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Objectives Low back pain (LBP) is a common reason for patients to present to emergency departments (EDs). Our objective was to describe the associations between depressive symptoms, pain severity, and functional impairment up to 3 months after initial ED presentation for LBP. Methods We performed a secondary analysis on an observational cohort of adult patients from a high‐volume, urban ED. Initial depressive symptoms (Patient Health Questionnaire‐9) and disability (Roland Morris Disability Questionnaire) were collected in person at the time of initial ED visit and by telephone at 1‐week and 3‐month follow‐ups. Pain intensity (Numeric Rating Scale) was collected at 1‐week and 3‐month follow‐ups. Our primary goal was to determine the associations between initial depressive symptoms and pain intensity and disability scores at 3 months. We also investigated the associations of initial and 3‐month change in depressive symptoms with change in disability score from initial presentation to 3 months and change in pain score from 1 week to 3 months. Results Of the 674 patients initially enrolled, 362 patients had complete depressive symptom, pain, and disability data and were included in the final analysis. Those with higher levels of intake depressive symptoms had worse pain intensity (B = 0.14, 95% confidence interval [CI] = 0.08 to 0.21) and disability (0.46, 95% CI = 0.30 to 0.62) severity at 3 months, with less improvement in disability over the 3 months (B = 0.22, 95% CI = 0.05 to 0.40). Furthermore, those with worsening depressive symptoms over the 3‐month study period experienced less improvement in pain intensity (B = 0.10, 95% CI = 0.05 to 0.17) and disability (B = 0.84, 95% CI = 0.66 to 1.02) over the same time frame. Except for a slight strengthening of the association between initial depressive symptom severity and 3‐month pain score among patients with no prior LBP episodes, history of prior LBP episodes did not moderate these relationships. Conclusions Significant positive temporal associations exist between initial severity and 3‐month progression of depressive symptoms and 3‐month pain intensity and disability outcomes for ED patients with LBP. Future work is needed to investigate whether behavioral interventions initiated from the ED may mitigate the incidence and severity of LBP‐related chronic pain and functional impairments.

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Section: Introductionmentioning

confidence: 99%

Depression and Functional Outcomes in Patients Presenting to the Emergency Department With Low Back Pain

Ring

Peskoe

Zhao

et al. 2020

Academic Emergency Medicine

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“…the trajectory of a condition based on certain subgroup factors) of people with LBP, it is critical to account for the patients' pain and disability when they are first assessed, as these factors are the strongest and most consistent predictors of pain and disability in the months after LBP incidence [147][148][149][150] . The STarT Back tool was typically (in six 71,72,83,90,93,102 of eight 78,91 studies and 2080 of 2634 patients) able to predict future disability, but this was less consistent for pain intensity (two 90,91 of six 71,72,78,93 studies and 348 of 1899 patients). For the McKenzie method, no studies assessed the effectiveness of the classification method on future pain intensity while accounting for baseline values.…”

Section: Discussionmentioning

confidence: 95%

Artificial intelligence to improve back pain outcomes and lessons learnt from clinical classification approaches: three systematic reviews

et al. 2020

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Artificial intelligence and machine learning (AI/ML) could enhance the ability to detect patterns of clinical characteristics in lowback pain (LBP) and guide treatment. We conducted three systematic reviews to address the following aims: (a) review the status of AI/ML research in LBP, (b) compare its status to that of two established LBP classification systems (STarT Back, McKenzie). AI/ML in LBP is in its infancy: 45 of 48 studies assessed sample sizes <1000 people, 19 of 48 studies used ≤5 parameters in models, 13 of 48 studies applied multiple models and attained high accuracy, 25 of 48 studies assessed the binary classification of LBP versus no-LBP only. Beyond the 48 studies using AI/ML for LBP classification, no studies examined use of AI/ML in prognosis prediction of specific subgroups , and AI/ML techniques are yet to be implemented in guiding LBP treatment. In contrast, the STarT Back tool has been assessed for internal consistency, test−retest reliability, validity, pain and disability prognosis, and influence on pain and disability treatment outcomes. McKenzie has been assessed for inter-and intra-tester reliability, prognosis, and impact on pain and disability outcomes relative to other treatments. For AI/ML methods to contribute to the refinement of LBP (sub-)classification and guide treatment allocation, large data sets containing known and exploratory clinical features should be examined. There is also a need to establish reliability, validity, and prognostic capacity of AI/ML techniques in LBP as well as its ability to inform treatment allocation for improved patient outcomes and/or reduced healthcare costs.

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“…16 As has been seen in previous work, a majority of patients with acute, nonradicular LBP demonstrate substantial improvement after 1 week, but nearly onequarter continue to report moderate or severe pain and functional impairment. 17 Unfortunately, it has proven difficult to predict during the baseline ED visit which patients are most likely to experience poor back pain-related outcomes. 17 Clinicians should prepare all patients for the possibility that their pain and functional impairment may linger for at least 1 week and in many cases longer.…”

Section: Discussionmentioning

confidence: 99%

“…17 Clinicians should prepare all patients for the possibility that their pain and functional impairment may linger for at least 1 week and in many cases longer. 17…”

Section: Discussionmentioning

confidence: 99%

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Ibuprofen Plus Acetaminophen Versus Ibuprofen Alone for Acute Low Back Pain: An Emergency Department–based Randomized Study

Friedman

Irizarry

Chertoff

et al. 2020

Academic Emergency Medicine

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Objectives Patients with low back pain (LBP) are often treated with nonsteroidal anti‐inflammatory drugs (NSAIDs). NSAIDs are modestly effective for LBP, but many patients with LBP continue to suffer despite treatment with these medications. We compared pain and functional outcomes 1 week after emergency department (ED) discharge among patients randomized to a 1‐week course of ibuprofen plus acetaminophen versus ibuprofen plus placebo. Methods This was a randomized, double‐blind study conducted in two urban EDs. Patients presenting with acute, nontraumatic, nonradicular LBP of no more than 2 weeks’ duration were eligible for enrollment immediately prior to discharge from an ED if they had a score > 5 on the Roland Morris Disability Questionnaire (RMDQ), a 24‐item validated instrument, indicating more than minimal functional impairment. All patients were given a standardized 10‐minute LBP educational session prior to discharge. The primary outcome was improvement on the RMDQ between ED discharge and 1 week later. One secondary outcome was pain intensity, as measured on a 4‐point descriptive scale (severe, moderate, mild, none) at 1 week. Results Enrollment began in October 2018. A total of 120 patients met selection criteria and were randomized. Baseline demographic characteristics were comparable between the two groups. By 1 week after the ED visit, patients randomized to ibuprofen plus placebo reported a mean (±SD) improvement in the RMDQ of 11.9 (±9.7), while those randomized to ibuprofen plus acetaminophen reported a mean (±SD) improvement of 11.1 (±10.7). The 95% CI for the between‐group difference of 0.8 was −3.0 to 4.7. At 1 week, moderate or severe pain was reported by 15 of 53 (28%) patients in the ibuprofen plus placebo group and 16 of 57 (28%) patients in the ibuprofen plus acetaminophen group (95% CI for between‐group difference of 0% = −17% to 17%). Conclusion Among ED patients with acute, nontraumatic, nonradicular LBP, adding acetaminophen to ibuprofen does not improve outcomes within 1 week.

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Pain One Week After an Emergency Department Visit for Acute Low Back Pain Is Associated With Poor Three‐month Outcomes

Cited by 18 publications

References 16 publications

Depression and Functional Outcomes in Patients Presenting to the Emergency Department With Low Back Pain

Depression and Functional Outcomes in Patients Presenting to the Emergency Department With Low Back Pain

Artificial intelligence to improve back pain outcomes and lessons learnt from clinical classification approaches: three systematic reviews

Ibuprofen Plus Acetaminophen Versus Ibuprofen Alone for Acute Low Back Pain: An Emergency Department–based Randomized Study

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