Up to 70 percent of us will experience low back pain in our lifetimes and many will progress to long term, chronic low back pain. Research reported in The Journal of Pain shows that high pain intensity at onset is predictive of future pain and disability, even after five years. The Journal of Pain is the peer-reviewed publication of the American Pain Society.
Researchers with the Arthritis Research U.K. Primary Care Centre evaluated 488 primary care practice patients who sought treatment for low-back pain. The intent of the study was to determine which prognostic factors best predict poor pain and disability outcomes five years later, and compare these factors with short-term outcomes at six month follow-up. Study subjects were mailed questionnaires soon after their physician visits and were surveyed after six months and at five years. Pain and disability were measured using the Chronic Pain Grade, a seven-item chronic pain assessment tool.
Potential predictive factors were organized in four categories: demographic, physical, psychological and occupational. After six months, the results showed that baseline pain intensity was associated with a 12 percent higher risk for developing chronic low back pain and patient beliefs that pain would persist conveyed a 4 percent risk increase. After five years, baseline pain intensity yielded a 9 percent increased risk for chronic pain, while believing that pain would persist had increased the risk by 6 percent.
The authors noted that their research confirms previous studies concluding that baseline pain intensity is a key predictor of future pain and disability. This study, however, is the first to demonstrate this association over a long period of time.
Clinically, the study confirms that effective pain relief in the initial management of low-back pain has implications for long-term improvement. Also, patient beliefs that pain will persist a long time can predict progression to clinically significant low back pain independent of a wide range of other prognostic factors.
- Paul Campbell, Nadine E. Foster, Elaine Thomas, Kate M. Dunn. Prognostic Indicators of Low Back Pain in Primary Care: Five-Year Prospective Study. The Journal of Pain, 2013; 14 (8): 873 DOI: 10.1016/j.jpain.2013.03.013
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