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Will this patient develop persistent disabling low back pain?

Roger Chou1, Paul Shekelle

  • 1Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, MC BICC, Portland, OR 97239, USA. chour@ohsu.edu

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|April 8, 2010
PubMed
Summary
This summary is machine-generated.

Identifying persistent disabling low back pain is crucial for effective management. Maladaptive coping behaviors, nonorganic signs, and functional impairment are key predictors of poor outcomes.

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Area of Science:

  • Medical research
  • Clinical epidemiology
  • Pain management

Background:

  • Low back pain is a prevalent condition affecting a significant portion of the population.
  • Early identification of individuals at risk for persistent disabling symptoms is essential for guiding treatment and follow-up strategies.

Purpose of the Study:

  • To systematically review the predictive utility of individual risk factors and clinical instruments for identifying patients likely to develop persistent disabling low back pain.
  • To synthesize evidence on factors associated with both persistent disabling pain and recovery.

Main Methods:

  • Conducted systematic electronic searches of MEDLINE and EMBASE databases, supplemented by reviewing bibliographies of relevant articles.
  • Included prospective studies of patients with less than 8 weeks of low back pain, calculating likelihood ratios (LRs) for clinical findings.
  • Data extraction and assessment were performed independently by two authors to ensure reliability.

Main Results:

  • Analysis of 20 studies (10,842 patients) identified nonorganic signs (LR, 3.0), maladaptive pain coping behaviors (LR, 2.5), high functional impairment (LR, 2.1), psychiatric comorbidities (LR, 2.2), and low general health status (LR, 1.8) as predictors of worse outcomes.
  • Low fear avoidance (LR, 0.39) and low functional impairment (LR, 0.40) were associated with recovery.
  • Work environment, baseline pain, radiculopathy, prior episodes, and demographics showed limited predictive value.

Conclusions:

  • Maladaptive pain coping behaviors, nonorganic signs, functional impairment, general health status, and psychiatric comorbidities are the most significant predictors of persistent disabling low back pain.
  • While risk prediction instruments exist, their validation is limited, and individual factors often provide comparable predictive information.