Centralization phenomenon as a prognostic factor for chronic low back pain and disability

Area of Science:

• Orthopedics
• Physical Therapy
• Pain Management

Background:

• Psychosocial factors are known predictors of chronic low back pain disability.
• Physical examination findings rarely predict long-term pain behavior.
• Dynamic assessment during treatment may aid in patient classification and prognosis.

Purpose of the Study:

• To determine if the centralization phenomenon (CP) and psychosocial variables predict chronic pain or disability in acute low back pain.
• To investigate the predictive value of dynamic changes in clinical measures during conservative treatment.

Main Methods:

• Prospective study of 223 adults with acute low back pain treated conservatively using McKenzie methods.
• Assessment of 23 independent variables (psychosocial, clinical, demographic) at intake and discharge.
• Classification of patients based on pain centralization during repeated trunk movements and follow-up at 12 months for pain, work status, and healthcare utilization.

Main Results:

• Nine independent variables predicted pain symptoms or disability.
• Pain pattern classification (noncentralization) and presence of leg pain at intake were the strongest predictors of chronicity.
• Dynamic assessment of pain centralization during treatment proved predictive.

Conclusions:

• Dynamic assessment of changes in pain location during treatment is a predictor of developing chronic pain and disability.
• Leg pain at initial assessment is also a significant predictor of long-term outcomes in acute low back pain patients.