Back Pain in Primary Care

TLDR

Outcomes of primary‑care back‑pain patients (N = 1128) were followed for one year, assessing changes in depression and identifying predictors of poor outcome. Less than one in five patients had recent onset, yet 69–82 % reported pain one year later, 14–21 % had poor functional outcomes, and predictors of poor outcome were pain‑related disability, duration of pain, lower education, and female gender, showing that pain persistence and intensity rather than onset recency best predict long‑term outcomes.

Abstract

Outcomes of primary care back pain patients (N = 1128) were studied at 1 year after seeking care. Changes in depression depending on outcome, and predictors of poor outcome were evaluated. Less than one back pain patient in five reported recent onset (first onset within the previous 6 months). One year after seeking care, the large majority of both recent and nonrecent-onset patients reported having back pain in the previous month (69% vs. 82%). A significant minority of both recent and nonrecent-onset patients had either a poor functional outcome (14% vs. 21%) or continuing high intensity pain without appreciable disability (10% vs. 16%). Predictors of poor outcome included pain-related disability, days in pain, lower educational attainment, and female gender. Among initially dysfunctional patients with persistent pain, one half were improved and one third had a good outcome at the 1-year follow-up. Among initially dysfunctional patients who experienced a good outcome, elevated depressive symptoms Improved to normal levels at follow-up. The outcome of back pain was predicted by pain-related disability and days in pain rather than by recency of onset, so it may be more meaningful to distinguish characteristic levels of pain intensity, pain-related disability, and pain persistence than to classify patients as acute or chronic.