Prognostic Indicators of Low Back Pain in Primary Care: Five-Year Prospective Study

Abstract

UNLABELLED: Back pain is common and many people experience long-term problems, yet little is known about what prognostic factors predict long-term outcomes. This study's objective was to determine which factors predict short- and long-term outcomes in primary care consulters with low back pain (LBP). Analysis was carried out on 488 patients who had consulted their physician about LBP. Patients were followed up at 6 months and 5 years. Clinically significant LBP at follow-up was defined as a score of 2, 3, or 4 on the Chronic Pain Grade, indicating substantial pain and disability. Cox regression was used to estimate relative risks (RRs) with 95% confidence intervals (CIs) on 32 potential predictive factors, organized into domains (demographic, physical, psychological, and occupational). Baseline pain intensity conferred a 12% increase in risk (RR = 1.12, 95% CI = 1.03-1.20), and patients' belief that their LBP would persist conferred a 4% increase in risk (RR = 1.04, 95% CI = 1.01-1.07) for poor outcome at 6 months. Outcome at 5 years was best predicted by a model with the same factors as in the 6-month model: pain intensity increased risk by 9% (RR = 1.09, 95% CI = .997-1.20), and a belief that their LBP would persist increased risk by 6% (RR = 1.06, 95% CI = 1.03-1.09). Both predictors have the potential to be targets for clinical intervention. PERSPECTIVE: Few studies have investigated factors that predict long-term back pain. This study has shown that pain intensity experienced during a period of primary care consultation, and patients' perception about whether their back pain will persist, were significant predictors of poor outcome at 6 months and at 5 years.

Shown for reading. Its publisher allows quoting it, not republishing it.

References 45

1. 1.

   Artus M., van der Windt D.A., Jordan K.P., Hay E.M. Low back pain symptoms show a similar pattern of improvement following a wide range of primary care treatments: A systematic review of randomized clinical trials. Rheumatology (Oxford). 2010;49:2346-2356.

   Not in our library10.1093/rheumatology/keq245

2. 2.

   Bowling A. 1997.

   Not in our library

3. 3.

   Brown G.K., Nicassio P.M. Development of a questionnaire for the assessment of active and passive coping strategies in chronic pain patients. Pain. 1987;31:53-64.

   Not in our library10.1016/0304-3959(87)90006-6

4. 4.

   Burton A.K., McClune T.D., Clarke R.D., Main C.J. Long-term follow-up of patients with low back pain attending for manipulative care: Outcomes and predictors. Man Ther. 2004;9:30-35.

   Not in our library10.1016/s1356-689x(03)00052-3

5. 5.

   Dunn K.M., Croft P.R. The importance of symptom duration in determining prognosis. Pain. 2006;121:126-132.

   Not in our library10.1016/j.pain.2005.12.012

6. 6.

   Dunn K.M., Jordan K., Croft P.R. Characterizing the course of low back pain: A latent class analysis. Am J Epidemiol. 2006;163:754-761.

   Not in our library10.1093/aje/kwj100

7. 7.

   Dunn K.M., Jordan K.P., Croft P.R. Recall of medication use, self-care activities and pain intensity: A comparison of daily diaries and self-report questionnaires among low back pain patients. Primary Health Care Res Develop. 2010;11:93-102.

   Not in our library

8. 8.

   Dunn K.M., Jordan K.P., Croft P.R. Contributions of prognostic factors for poor outcome in primary care low back pain patients. Eur J Pain. 2011;15:313-319.

   Not in our library10.1016/j.ejpain.2010.07.008

9. 9.

   Elliott A.M., Smith B.H., Smith W.C., Chambers W.A. Changes in chronic pain severity over time: The Chronic Pain Grade as a valid measure. Pain. 2008;88:303-308.

   Not in our library10.1016/s0304-3959(00)00337-7

10. 10.

    Foster N.E., Bishop A., Thomas E., Main C., Horne R., Weinman J., Hay E. Illness perceptions of low back pain patients in primary care: What are they, do they change and are they associated with outcome? Pain. 2008;136:177-187.

    Not in our library10.1016/j.pain.2007.12.007

11. 11.

    George C. The six-month incidence of clinically significant low back pain in the Saskatchewan adult population. Spine. 2002;27:1778-1782.

    Not in our library10.1097/00007632-200208150-00017

12. 12.

    Grotle M., Foster N.E., Dunn K.M., Croft P. Are prognostic indicators for poor outcome different for acute and chronic low back pain consulters in primary care? Pain. 2010;151:790-797.

    Not in our library10.1016/j.pain.2010.09.014

13. 13.

    Hale E.D., Treharne G.J., Kitas G.D. The common sense model of self-regulation of health and illness: How can we use it to understand and respond to our patients' needs? Rheumatology (Oxford). 2007;46:904-906.

    Not in our library10.1093/rheumatology/kem060

14. 14.

    Harland N.J., Georgieff K. Development of the Coping Strategies Questionnaire 24, a clinically utilitarian version of the Coping Strategies Questionnaire. Rehabil Psychol. 2003;48:296-300.

    Not in our library

15. 15.

    Hayden J.A., Dunn K.M., van der Windt D.A., Shaw W.S. What is the prognosis of back pain? Best Pract Res Clin Rheumatol. 2010;24:167-179.

    Not in our library10.1016/j.berh.2009.12.005

16. 16.

    Henschke N., Maher C.G., Refshauge K.M., Herbert R.D., Cumming R.G., Bleasel J., York J., Das A., McAuley J.H. Prognosis in patients with recent onset low back pain in Australian primary care: Inception cohort study. BMJ. 2008;337:a171.

    Not in our library10.1136/bmj.a171

17. 17.

    Hestbaek L., Leboeuf-Yde C., Manniche C. Low back pain: What is the long term course? A review of studies of general patient populations. Eur Spine J. 2003;12:149-165.

    Not in our library10.1007/s00586-002-0508-5

18. 18.

    Hoy D., Brooks P., Blyth F., Buchbinder R. The epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010;24:769-781.

    Not in our library10.1016/j.berh.2010.10.002

19. 19.

    Katz M.H. 2006.

    Not in our library

20. 20.

    Kori S.H., Miller R.P., Todd D.D. Kinesiophobia: A new view of chronic pain behaviour. Pain Manag. 1990;3:35-43.

    Not in our library

21. 21.
    Pain in the lumbar, thoracic or cervical regions: do age and gender matter? A population-based study of 34,902 Danish twins 20–71 years of age · 2009

    No notice
22. 22.

    Lumley T, Kronmal R, Shuangge M: Relative risk regression in medical research: Models, contrasts, estimators and algorithms. UW Biostatistics Working Paper Series, paper 293. Available at: http://www.bepress.com/uwbiostat/paper293. Accessed February 2013

    Not in our library

23. 23.

    Main C.J., Foster N., Buchbinder R. How important are back pain beliefs and expectations for satisfactory recovery from back pain. Best Pract Res Clin Rheumatol. 2010;24:205-217.

    Not in our library10.1016/j.berh.2009.12.012

24. 24.

    Mallen C.D., Peat G., Thomas E., Dunn K.M., Croft P.R. Prognostic factors for musculoskeletal pain in primary care: A systematic review. Br J Gen Pract. 2007;57:655-661.

    Not in our library

25. 25.

    Manchikanti L., Singh V., Datta S., Cohen S.P., Hirsch J.A. Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Physician. 2009;12:E35-E70.

    Not in our library

26. 26.

    Moss-Morris R.W., Weinman J., Petrie K.J., Horne R., Cameron L.D., Buick D. The revised Illness Perception Questionnaire (IPQ-R). Psychol Health. 2002;17:1-16.

    Not in our library

27. 27.

    Nicholas M.K. The pain self-efficacy questionnaire: Taking pain into account. Eur J Pain. 2007;11:153-163.

    Not in our library10.1016/j.ejpain.2005.12.008

28. 28.

    Nicholas M.K., Linton S.J., Watson P.J., Main C.J. Early identification and management of psychological risk factors (“yellow flags”) in patients with low back pain: A reappraisal. Phys Ther. 2011;91:737-753.

    Not in our library10.2522/ptj.20100224

29. 29.

    Office for National Statistics. 2002.

    Not in our library

30. 30.

    Papageorgiou A.C., Croft P.R., Ferry S., Jayson M.I., Silman A.J. Estimating the prevalence of low back pain in the general population. Evidence from the South Manchester Back Pain Survey. Spine. 1995;20:1889-1894.

    Not in our library10.1097/00007632-199509000-00009

31. 31.

    Picavet H.S.J., Schouten J.S. Musculoskeletal pain in the Netherlands: Prevalences, consequences and risk groups, the DMC3-study. Pain. 2003;102:167-178.

    Not in our library10.1016/s0304-3959(02)00372-x

32. 32.

    Pincus T., Burton A.K., Vogel S., Field A.P. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine. 2002;27:E109-E120.

    Not in our library10.1097/00007632-200203010-00017

33. 33.

    Porcheret M., Hughes R., Evans D., Jordan K., Whitehurst T., Ogden H., Croft P. North Staffordshire general practice research network. Data quality of general practice electronic health records: The impact of a program of assessments, feedback, and training. J Am Med Inform Assoc. 2004;11:78-86.

    Not in our library10.1197/jamia.m1362

34. 34.

    Ramond A., Bouton C., Richard I., Roquelaure Y., Baufreton C., Legrand E., Huez J.F. Psychosocial risk factors for chronic low back pain in primary care—A systematic review. Fam Pract. 2011;28:12-21.

    Not in our library10.1093/fampra/cmq072

35. 35.

    Roland M., Morris R. A study of the natural history of back pain. Part I: Development of a reliable and sensitive measure of disability in low-back pain. Spine. 1983;8:141-144.

    Not in our library10.1097/00007632-198303000-00004

36. 36.

    Savigny P, Kuntze S, Watson P, Underwood M, Ritchie G, Cotterell M, Hill D, Browne N, Buchanan E, Coffrey P, Dixon P, Drummond C, Flanagan M, Greenough C, Griffiths M, Halliday-Bell J, Hettinga D, Vogel S, Walsh D. Low back pain: Early management of persistent non-specific low back pain. National Collaborating Centre for Primary Care and Royal College of General Practitioners, London (14), 2009

    Not in our library

37. 37.

    Smith B.H., Penny K.I., Purves A.M., Munro C., Wilson B., Grimshaw J., Chambers A.W., Cairns Smith W. The Chronic Pain Grade questionnaire: Validation and reliability in postal research. Pain. 1997;71:141-147.

    Not in our library10.1016/s0304-3959(97)03347-2

38. 38.

    Steenstra I.A., Verbeek J.H., Heymans M.W., Bongers P.M. Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: A systematic review of the literature. Occup Environ Med. 2005;62:851-860.

    Not in our library10.1136/oem.2004.015842

39. 39.

    Thompson B. Stepwise regression and stepwise discriminant analysis need not apply here: A guidelines editorial. Educ Psychol Meas. 1995;55:525-534.

    Not in our library

40. 40.

    Thompson M.L., Myers J.E., Kriebel D. Prevalence odds ratio or prevalence ratio in the analysis of cross sectional data: What is to be done? Occup Environ Med. 1998;55:272-277.

    Not in our library10.1136/oem.55.4.272

Cited by papers we hold 3

• Prognostic factors for pain chronicity in low back pain: a systematic review · 2021
  No notice
• Prognostic indicators for poor outcomes in low back pain patients consulted in primary care. · 2020
  Not checked
• Trajectories and predictors of the long-term course of low back pain: cohort study with 5-year follow-up · 2017
  No notice

Reads

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.