Predictors of Low Back Pain Improvement
The authors of this current study begin by proposing that the chronicity of low back pain is not only related to the low back pain episode but also factors present prior to the onset of symptoms. The authors' objective was to determine whether pre-morbid and episode-specific factors can predict early improvement of low back pain symptoms.
4501 adults, registered with two general practices, completed a questionnaire relating to the onset and outcome of LBP. Specifically the questionnaire asked about LBP in the past, current LBP symptoms, self-perceived general health, smoking status, height/weight, general level of physical activity, work status, satisfaction with employment or unemployment, income level, and the presence of psychological distress. Any subjects who had an episode of LBP in the 18 months following completion of the questionnaire were examined and interviewed. Further questioning ensued related to the episode: the symptom onset timing, what the patient believed caused the onset, and the duration of the episode.
During the 18-month follow up 174 (9.2%) males and 268 (10.2%) presented with back pain. The strongest predictors of early improvement, for males, were: low levels of psychological stress, being employed and satisfied at work, high physical activity, and good general health. Those patients with a high degree of psychological distress were less likely to improve quickly; furthermore, the findings of this study indicate that adverse psychological factors existed prior to the onset of symptoms rather than just occur as a consequence.
Predictors also emerged for women, but they seemed to be only related to the specific episode: a sudden onset of pain, pain localized to back, and the perception that symptoms were not work-related resulted in quicker recovery. 77% had reported improvement by one to two weeks. Overall, the researchers found by one to two weeks post-consultation an improvement does occur; yet in only 5% of the cases is there complete resolution. The authors found that the pre-morbid factors that played a role in the back pain of men did not have an effect in women:
"In females, we have shown that the information collected on pre-morbid and episode related-factors, and in particular those factors which were associated with outcome in males, did not predict outcome well. This reflects either the necessity to use more detailed instruments for collecting information relating to the low back pain episode and psychosocial factors, or the importance of other, as yet unknown, influences on outcome."
Macfarlane GJ, Thomas E, Croft PR, et al. Predictors of early improvement in low back pain amongst consulters to general practice: the influence of pre-morbid and episode-related factors. Pain 1999;80:113-119.
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