Link Between Psychological Factors And Chronicity Of Lower Back Pain

Main Category: Back Pain
Also Included In: Psychology / Psychiatry
Article Date: 25 Aug 2005 - 15:00 PDT

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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 Morris 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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