Risk Factors Associated With Transition From Acute to Chronic Low Back Pain in US Patients Seeking Primary Care

Abstract

Key Points Question Is the transition from acute to chronic low back pain (LBP) associated with risk strata, defined by a standardized prognostic tool, and/or with early exposure to guideline nonconcordant care? Findings In this cohort study of 5233 patients with acute LBP from 77 primary care practices, nearly half the patients were exposed to at least 1 guideline nonconcordant recommendation within the first 21 days after the index visit. Patients were significantly more likely to transition to chronic LBP as their risk on the prognostic tool increased and as they were exposed to more nonconcordant recommendations. Meaning In this study, the transition rate to chronic LBP was substantial and increased correspondingly with risk strata and early exposure to guideline nonconcordant care.

The Understanding persistent Pain Where it ResiDes study of low back pain cohort profile

“…Similar difficulties with recruitment have been reported by other groups conducting experimental LBP cohort studies [27;35]. Cohort studies conducted alongside randomized trials of new treatments appear to have greater recruitment success [50] and this may be an important consideration for future LBP cohort study designs.…”

Association between type 2 diabetes and chronic low back pain in general practices in Germany

“…24 Interestingly, depression and other psychiatric disorders such as anxiety are also key factors in the transition from acute low back pain to CLBP. 13 Furthermore, type 2 diabetes and CLBP share common risk factors such as obesity and low-grade systemic inflammation, and regression analyses conducted in this study were therefore adjusted for obesity. In terms of low-grade systemic inflammation, there is a strong body of literature showing that this factor likely plays an important role in the etiology of both type 2 diabetes 27 34 and CLBP.…”

“…CLBP is a complex disorder that is associated with a wide range of sociodemographic and psychological factors such as low educational attainment, 11 workload, 12 and psychological comorbidities. 13 In terms of chronic physical conditions, an increasing body of research has investigated the relationship between diabetes and back pain, but there are some discrepancies in the results of these studies. [14][15][16][17][18][19][20][21] For example, a Spanish case-control study including 4190 individuals with and without diabetes revealed that CLBP and chronic neck pain were more common in people with diabetes.…”

The Role of Chiropractic Care in Providing Health Promotion and Clinical Preventive Services for Adult Patients with Musculoskeletal Pain: A Clinical Practice Guideline

“…53 Secondary prevention of pain: Chiropractic management that includes spinal manipulation, lifestyle counseling and other non-pharmaceutical approaches may contribute to secondary prevention of pain by shortening the duration of acute pain but little evidence supports spinal manipulation alone in preventing the transition from acute to chronic pain. 47,61,71 Tertiary prevention of pain: Substantial evidence supports chiropractic management that includes spinal manipulation, lifestyle counseling, and other non-pharmaceutical approaches for tertiary prevention of pain. 11,[72][73][74][75] Recommendations for primary prevention of disease and disability…”