Estimating the Risk of Chronic Pain for Patients with Acute Low Back Pain
Written by Editor   
Wednesday, November 30, 2016 12:00 AM

News Bite: A five question prognostic model for patients with acute LBP may be a useful tool for estimating risk of chronic LBP.

Low back pain (LBP) is a major global health problem that, compared to all other diseases and health conditions, is responsible for the most years lived with disability, an estimated 80 million years in 2010. The costs of care, investigations, and lost productivity associated with LBP are a significant economic burden for industrialized nations.  Globally, LBP is responsible for the most years lived with disability. The most problematic type of LBP is chronic LBP (pain lasting longer than 3 mo); it has a poor prognosis and is costly, and interventions are only moderately effective. 

Targeting interventions according to risk profile is a promising approach to prevent the onset of chronic LBP. Developing accurate prognostic models is the first step. No validated prognostic models are available to accurately predict the onset of chronic LBP. The primary aim of this study was to develop and validate a prognostic model to estimate the risk of chronic LBP.

Data from 2,758 patients with acute LBP attending primary care in Australia between 5 November 2003 and 15 July 2005 and between 10 November 2009 and 5 February 2013 were used to develop and externally validate the model. In the external validation sample, the primary model (PICKUP) discriminated between those who did and did not develop chronic LBP with acceptable performance. Although model calibration was also acceptable in the external validation sample, some miscalibration was observed for high-risk groups. 

The decision curve analysis estimated that, if decisions to recommend further intervention were based on risk scores, screening could lead to a net reduction of 40 unnecessary interventions for every 100 patients presenting to primary care compared to a “treat all” approach. Limitations of the method include the model being restricted to using prognostic factors measured in existing studies and using stepwise methods to specify the model. 

Based on its performance in these cohorts, this five-item prognostic model for patients with acute LBP may be a useful tool for estimating risk of chronic LBP. Further validation is required to determine whether screening with this model leads to a net reduction in unnecessary interventions provided to low-risk patients.