Predicting who develops chronic low back pain in primary care: a prospective study

BMJ 1999;318:1662-1667 ( 19 June )

General Practice

Predicting who develops chronic low back pain in primary care: a prospective study

Elaine Thomas, research statistician, ^a Alan J Silman, professor and director, ^a Peter R Croft, professor, ^b Ann C Papageorgiou, studies coordinator, ^a Malcolm I V Jayson, professor, ^c Gary J Macfarlane, senior lecturer. ^a

^a Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, Medical School, University of Manchester, Manchester M13 9PT, ^b University of Keele, School of Postgraduate Medicine, Industrial and Community Health Research Centre, Hartshill, Stoke on Trent ST4 7QB, ^c Rheumatic Diseases Centre, University of Manchester, Clinical Sciences Building, Hope Hospital, Salford M6 8HD

Correspondence to: GJ Macfarlane G.Macfarlane{at}man.ac.uk

Objectives: To quantify the relative contribution of premorbidand episode specific factors in determining the long term persistenceof disabling symptoms of low backpain.
Design: Prospective cohortstudy.
Setting: Two general practices in the south Manchesterarea.
Participants: 180 patients, who previously participatedin a cross sectional population survey, who consulted becauseof low back pain during the study period. They were followed at1 week and 3 and 12 months afterconsultation.
Main outcome measure: Persistent disabling low back pain in the12 months after theconsultation.
Results: Disabling low back pain persisted in one thirdof participants after consultation and was more common with increasingage, among those with a history of low back pain, and in women.Persistence of symptoms was associated with "premorbid" factors(high levels of psychological distress (odds ratio 3.3; 95% confidenceinterval 1.5 to 7.2), poor self rated health (3.6; 1.9 to 6.8),low levels of physical activity (2.8; 1.4 to 5.6), smoking (2.1;1.0 to 4.3), dissatisfaction with employment (2.4; 1.3 to 4.5))and factors related to the episode of low back pain (durationof symptoms, pain radiating to the leg (2.6; 1.3 to 5.1), widespreadpain (6.4; 2.7 to 15), and restriction in spinal mobility). Amultivariate model based on six factors identified groups whoselikelihood of persistent symptoms ranged from 6% to 70%.
Conclusions: The presence of persistent low back pain isdetermined not only by clinical factors associated with pain butalso by the premorbidstate.

Key messages

Although many episodes of acute low back pain will resolve rapidly, around 30% result in persistent disabling symptoms
The presence of persistent low back pain is not only determined by clinical factors at the time of onset but also by the "premorbid" state
Patients with these adverse prognostic factors represent a group in which effective interventions may result in substantially reduced morbidity and healthcare costs

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Should treatment of (sub)acute low back pain be aimed at psychosocial prognostic factors? Cluster randomised clinical trial in general practice: Petra Jellema, Daniëlle A W M van der Windt, Henriëtte E van der Horst, Jos W R Twisk, Wim A B Stalman, and Lex M Bouter
BMJ 2005 331: 84. [Abstract] [Full Text] [PDF]

Persistent back pain can be predicted
BMJ 1999 318: 0. [Full Text]

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