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 premorbid and episode specific factors in determining the long term persistence of disabling symptoms of low back pain.
Design: Prospective cohort study.
Setting: Two general practices in the south Manchester area.
Participants: 180 patients, who previously participated in a cross sectional population survey, who consulted because of low back pain during the study period. They were followed at 1 week and 3 and 12 months after consultation.
Main outcome measure: Persistent disabling low back pain in the 12 months after the consultation.
Results: Disabling low back pain persisted in one third of participants after consultation and was more common with increasing age, 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% confidence interval 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 (duration of symptoms, pain radiating to the leg (2.6; 1.3 to 5.1), widespread pain (6.4; 2.7 to 15), and restriction in spinal mobility). A multivariate model based on six factors identified groups whose likelihood of persistent symptoms ranged from 6% to 70%.
Conclusions: The presence of persistent low back pain is determined not only by clinical factors associated with pain but also by the premorbid state.


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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