Physical symptoms and signs and chronic pain

Do physical findings that are used to indicate location and extent of tissue damage and a measure of the severity of initial pain predict subsequent reports of pain and of disability?

A standardized literature search identified one systematic review and 12 observational studies (9 low back pain, 2 neck pain, and 1 carpal tunnel syndrome) to provide evidence about these questions.

Most studies were of specific populations. These studies were useful studies of predictors, but they have limited generalizability. Exclusions and loss of subjects at follow-up in some studies also limited generalizability. Conclusions were made cautiously, because some factors with statistical correlations with chronic pain were not plausible predictors.

The studies provide moderate evidence (level 2) that reports of the intensity of pain in acute musculoskeletal injury predict subsequent reports of pain. There is limited evidence (level 3) that the location and extent of injury predict reports of pain and poor functional activity outcomes. There is moderate evidence (level 2) that physical symptoms and signs cannot be considered individual predictors of chronic pain disability as measured by participation outcomes. Instead, in the transition from subacute to chronic pain disability, functional disability and psychological distress play a more important role than pain intensity.