Study offers clinicians tool for managing risks for chronic low-back pain
By Mari-Len De
A new clinical decision rule for determining patients with higher risk of developing chronic low-back pain has been developed by researchers at the University of California San Francisco, University of Georgia and Kaiser Permanente.
Researchers said the new clinical decision rule may help primary care providers predict which patients with acute low-back pain will progress to chronic low-back pain, information from the U.S. revealed, according to an article posted on the U.S. National Center for Complementary and Integrative Health (NCCIH) website.
The study, funded in part by the NCCIH, was published in the March 14, 2015 issue of The Spine Journal.
The study involved an initial survey of 605 adults with acute low-back pain, followed by 521 adults surveyed at six months, and 443 at two years.
For purposes of the study, acute low-back pain was defined as back pain between the rib cage and buttocks of less than one month that was severe enough to seek medical care and was not preceded by any other episodes of low-back pain in the past year. The questionnaire assessed the history of prior pain episodes, duration of current episodes, pain intensity, number of days on sick leave and of reduced daily activities, perceived stress, and other parameters, the study explained.
The researchers identified optimal score cutoffs for creating low-risk, medium-risk and high-risk categories for the likelihood of developing chronic pain. At six months, 47 per cent of participants were categorized as low-risk, 38 per cent as medium-risk and 15 per cent as high-risk. At two years, these numbers were 49 per cent, 36 per cent and 15 per cent, respectively. At two years, 10 per cent of those categorized as low-risk had chronic low-back pain, while 20 per cent of those who were medium-risk and 42 per cent of those who were high-risk had chronic low-back pain.
Patients at high-risk of developing chronic low-back pain may warrant more intensive interventions, the researchers noted. “Those in the medium-risk group may need closer oversight by their primary care providers than the low-risk group, but it may be justified to suggest waiting a little longer before prescribing more intense and expensive treatment options.”
In the study, the researchers remarked there is an urgent need for a clinical decision tool for low-back pain, which is one of the most common and expensive conditions in primary care. They also noted that this rule should be validated in a separate study population.