Article Helps Identify Patients Prone to Persistent and Disabling Low Back Pain
Low back pain is the fifth most frequent reason for healthcare office visits in the United States, and patients who develop chronic disabling low back pain account for a markedly disproportionate share of the costs associated with low back pain. Early identification of patients more likely to develop persistent disabling symptoms could help guide decisions regarding follow-up and management. This review of the literature (1966 through February 2010) sought to examine the usefulness of individual risk factors or risk prediction instruments for identifying patients more likely to develop persistent, disabling low back pain. Investigators identified 20 studies that evaluated more than 10,000 patients with fewer than eight weeks of low back pain, and that prospectively evaluated the prognostic accuracy of individual risk factors or risk prediction instruments.
Findings show that the most helpful components for predicting persistent, disabling low back pain were maladaptive pain coping behaviors (e.g., avoidance of work), nonorganic signs (e.g., suggests strong psychological component of pain), functional impairment, general health status, and presence of psychiatric comorbidities. For example, worse general health status before the onset of pain was associated with worse outcomes at three and six months, and the presence of higher scores for current psychiatric comorbidity had a somewhat stronger effect on outcomes than poorer general health at three and six months. In addition, baseline functional impairment showed an increasing likelihood of poor outcomes at three to six months and at one year. However, patients’ age, sex, education level, smoking status, and overweight status consistently failed to predict worse outcomes. Results also show that several risk prediction instruments were useful for predicting outcomes, but none were extensively validated, thus more research is recommended in this area.
Chou R and Shekelle P. Will this patient develop persistent disabling low back pain? “The Rational Clinical Examination” JAMA April 7, 2010;303(13):1295-1302.
Dr. Shekelle is part of HSR&D’s Center for the Study of Healthcare Provider Behavior located in Sepulveda, CA.