Link between psychological factors and chronicity of lower back pain

August 25, 2005

25 Aug 2005

A group of researchers from Oslo set out to determine whether there

was any predictive link between neurological markers present at

commencement of lower back pain (LBP), and the patient's prognosis at

12 months.

Excluding any patients with any red-flags or previous history of back

pain, investigators recruited 123 patients at the point of their

first presentation to primary care with LBP. They underwent an

initial clinical examination and assessment of psychological and

socio-demographic factors. Each patient was then reviewed every week

for the first month and subsequently at months 3, 6, 9 and 12. On

each of the follow-up checks patients were measured on three

outcomes: pain intensity, disability (Roland Disability

questionnaire (RMQ)) and absence from work due to LBP.

Overall, there was a significant decrease in both pain and disability

over the course of the follow-up assessments and most patients were

fully recovered within the first month. However, specific review of

those patients who displayed neurological signs at the primary

consultation revealed significantly less improvement in both pain and

RMQ.

At the end of the 12 months, 17% of patients had not recovered (RMQ >

4) and 9% were still on sick leave. The only measured factors that

showed significant association to non-recovery were the psychological

screening and distress indicators.

This study provides strong evidence that detailed assessment of a

patient's psychological health is important when treating patients

with new onset LBP. Knowledge of neurological signs should steer

appropriate management and improve an otherwise inferior prognosis.

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