Make the Diagnosis: Will This Patient Develop Disabling Back Pain?
Patients who seek care for back pain of fewer than 8 weeks duration typically have nonspecific findings, and most patients get better. However, in primary care clinics, about 11% will have poor outcomes after 3-6 months with problems such as work absenteeism and workman's compensation claims. Studies show that problems with persistent pain and functional limitations occur in a median of 26% of patients at 3 months and 21% 1 year later. (See Original Article for references to support these data).
Demographic Characteristics, Work Factors, and Population Features for Predicting Chronic Disabling Back Pain
Most demographic features, work factors, and other population features are not highly useful for identifying patients with fewer than 8 weeks of back pain who are likely to recover vs those likely to experience chronic disabling back pain. The patient's age, sex, education level, smoking status, weight, and history of previous or recurrent episodes of back pain all fail to identify patients at either increased risk of poor outcomes or those likely to recover (LRs approach 1). Already receiving disability compensation (median LR 1.4), work dissatisfaction (LR 1.5), and higher work physical demands (median LR 1.4) are weak predictors of future disability at 1 year. Patients with higher levels of psychiatric comorbidity compared to those with fewer psychiatric comorbidities are at increased risk for having disabling back pain 1 year later (median LR 2.2) (see Table 76-1). (See Original Article for references to support these data).
Table 76-1Most Useful Findings for Predicting Chronic Disability Back Pain 1 Year Following Presentation of Back Pain Fewer Than 8 Weeks in Duration ||Download (.pdf) Table 76-1 Most Useful Findings for Predicting Chronic Disability Back Pain 1 Year Following Presentation of Back Pain Fewer Than 8 Weeks in Duration
|Finding ||Median LR+ (Range) ||Median LR- (Range) |
|More vs less widespread pain or somatization ||3.0 (1.7-4.6) ||0.71 (0.31-0.76) |
|Fear avoidance or maladaptive coping behaviora |
|High ||2.5 (2.2-2.8) |
|Medium ||1.2 (1.2-1.3) |
|Low ||0.39 (0.38-0.40) |
|Presence of higher levels of psychiatric comorbidities ||2.2 (1.9-2.3) ||0.85 (0.55-0.93) |
|Baseline functional impairmentb |
|High ||2.1 (2.3-3.7) |
|Medium ||0.86 (0.85-1.7) |
|Low ||0.40 (0.10-0.52) |
Signs and Symptoms for Predicting Chronic Disabling Back Pain
Certain signs and symptoms assessed at the time of initial presentation can be useful for predicting patients more likely to develop chronic disabling back pain (see Table 76-1). Patients with the ...