What is the association between the presence of comorbidities and the appropriateness of care for low back pain? A population-based medical record review study

Abstract

BackgroundAlthough “non-specific” in 90% of cases, low back pain (LBP) is often treated as an independent entity, even though comorbidities are commonly associated with it. There is evidence that some LBP may be related to chronic conditions or be a symptom of poor health. The purpose of this study was to clarify the extent of comorbidities amongst a cohort of Australian adults with LBP and examine if having concurrent conditions has any association with appropriateness of care for LBP.MethodsA population-based sample of patients with one or more of 22 common conditions was recruited by telephone; consents were obtained to review their medical records. Trained surveyors extracted information from their medical records to examine the care patients received for their LBP with respect to ten indicators of appropriate care, ratified by LBP experts. Using LBP as the index condition, lists of self-reported comorbidities and those that were documented in medical records were compared. Medical records were reviewed and analysed with respect to appropriateness of care to identify any significant differences in care received between patients with LBP only and those with LBP plus comorbidities.ResultsOne hundred and sixty four LBP patients were included in the analysis. Over 60% of adults with LBP in Australia had one of 17 comorbidities documented, with females being more likely than males to have comorbid conditions (63% vs 37%, p = 0.012). The more comorbidities, the poorer their reported health status (63% vs 30%, p = 0.006). Patients with comorbidities were significantly less likely to receive appropriate LBP care on nine of the ten LBP indicators (p < 0.05).ConclusionsThis study established that the presence of comorbidities is associated with poorer care for LBP. Understanding why this is so is an important direction for future research. Further studies using a larger cohort are needed to explore the association between comorbidities and appropriateness of care for LBP, to better inform guidelines and practice in this area.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2316-z) contains supplementary material, which is available to authorized users.

History of chronic disease is a novel intrinsic risk factor associated with gradual onset injuries in recreational road cyclists: A cross-sectional study in 21,824 cyclists - SAFER XIV

“…Finally, there may also be a relationship between chronic disease and chronic pain in athletes. (Ramanathan et al, 2018). However, it is important to note that, due to our cross-sectional design, we cannot establish a cause-effect relationship between chronic disease and GOIs in cyclists.…”

Factors associated with seeking medical care for low back pain in a twin adult sample

“…Alternatively, patients may adopt a self-perception that LBP is less threatening to one's health or is more self-manageable compared to comorbid health conditions, and are therefore more likely to seek care for the comorbid condition instead (Hurwitz et al, 1999;Idowu et al, 2015). It has also been found that LBP patients with comorbidities are less likely to receive appropriate care for their LBP, compared to LBP patients who do not have comorbidities (Ramanathan et al, 2018). For example, LBP patients with one comorbid condition are less likely to be examined for the presence of red flags (e.g., fractures, cancer, infection), whereas those suffering from three or more comorbidities are at higher risk of being prescribed unnecessary medications and failing to receive appropriate advice for managing their LBP (Ramanathan et al, 2018).…”

“…It has also been found that LBP patients with comorbidities are less likely to receive appropriate care for their LBP, compared to LBP patients who do not have comorbidities (Ramanathan et al, 2018). For example, LBP patients with one comorbid condition are less likely to be examined for the presence of red flags (e.g., fractures, cancer, infection), whereas those suffering from three or more comorbidities are at higher risk of being prescribed unnecessary medications and failing to receive appropriate advice for managing their LBP (Ramanathan et al, 2018). This pattern was mirrored by the significant inverse association we found between a history of diabetes and seeking medical care for LBP, highlighting the complexity of managing LBP in the presence of multimorbidities.…”

Translating clinical trials into improved real-world management of pain: convergence of translational, population-based, and primary care research

“…>65 years old) patients [49], yet this population is commonly excluded from RCTs [6]. Another critical gap in the generalizability of pain RCTs is the recognition that a substantial number of people with chronic pain have multiple pain etiologies and anatomical pain sites, as well as other coexisting multimorbidities [74] that often exclude them from classical RCTs with tight exclusion criteria. These well-recognized problems for RCTsin many areas -reveal a limited understanding of drug-drug, and drug-disease interactions relevant for older, multimorbid populations on multiple medications and require future study.…”

“…This study found a widespread mismatch between trials and disease burden for musculoskeletal conditions in all income level strata. Furthermore, other differences -with respect to pain prevalence and treatment -in sex/gender [51], race/ethnicity [14;33] and comorbidities [74] suggest other important evidence-burden gaps in real-world pain treatment and research.…”