Identifying Patients at Risk for Future Back Problems
Researchers keep trying to sort out back pain patients. What treatment would work best for each problem? What factors predict the outcome? Do patients on sick leave, retirement, or disability have different results from patients who aren't on any of these? Swedish scientists report the results of an ongoing study trying to answer these questions.
Patients in a previous study on back pain were included in this research project. They were contacted one year and five years after treatment. Data was collected on age, gender, smoking habits, and exercise and activity levels. Patients were asked if they were happy at work and how long their symptoms had lasted. They were also asked what they expected from treatment.
The authors report the following findings:
More patients who had sick leave or disability pensions were disabled than those who didn't have them
Women were more likely than men with similar back problems to be disabled after five years
Low exercise level before back pain started was linked with disability after five years
Age, expectations of treatment, and satisfaction at work were not major factors predicting disability
Factors predicting disability at one year were slightly different than factors linked with five-year results. For example women with lower physical activity had greater disability after five years, but not after the first year. Pain intensity and frequency affected the results after the first year but not as much after five years.
The authors say the results of this study should be viewed with caution. There may be other factors more important than the ones found here. For example, other studies list depression and older age (more than 65) as predictive variables. Age over 65 along with other illness added together may increase the risk of disability after five years.
More study is needed to identify and rank order (first, second, third) factors that put patients at high risk of long-term disability. It's important to keep following back pain patients after treatment to see what happens. We may be able to work backwards from this data to prevent disability when back pain occurs.
Paul Enthoven, et al. Predictive Factors for 1-Year and 5-Year Outcome for Disability in a Working Population of Patients with Low Back Pain Treated in Primary Care. In Pain. May 2006. Vol. 122. No. 1-2. Pp. 137-144.