Predicting the transition from acute to persistent low back pain

Occup Med (Lond). 2011 Mar;61(2):127-31. doi: 10.1093/occmed/kqq194. Epub 2011 Jan 3.


Background: Most people experience low back pain (LBP) at least once in their lifetime. Only a minority of them go on to develop persistent LBP. However, the socioeconomic costs of persistent LBP significantly exceed the costs of the initial acute LBP episode.

Aims: To identify factors that influence the progression of acute LBP to the persistent state at an early stage.

Methods: Prospective inception cohort study of patients attending a health practitioner for their first episode of acute LBP or recurrent LBP after a pain free period of at least 6 months. Patients were assessed at baseline addressing occupational and psychological factors as well as pain, disability, quality of life and physical activity and followed up at 3, 6, 12 weeks and 6 months. Variables were combined to the three indices 'working condition', 'depression and maladaptive cognitions' and 'pain and quality of life'.

Results: The index 'depression and maladaptive cognitions' was found to be a significant baseline predictor for persistent LBP up to 6 months (OR 5.1; 95% CI: 1.04-25.1). Overall predictive accuracy of the model was 81%.

Conclusions: In this study of patients with acute LBP in a primary care setting psychological factors at baseline correlated with a progression to persistent LBP up to 6 months. The benefit of including factors such as 'depression and maladaptive cognition' in screening tools is that these factors can be addressed in primary and secondary prevention.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Aged
  • Chronic Disease
  • Depressive Disorder / complications
  • Depressive Disorder / psychology*
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Low Back Pain / classification
  • Low Back Pain / complications
  • Low Back Pain / psychology*
  • Male
  • Middle Aged
  • New Zealand
  • Pain Measurement / psychology
  • Primary Health Care
  • Prospective Studies
  • Quality of Life / psychology*
  • Risk Factors
  • Surveys and Questionnaires
  • Work Schedule Tolerance / psychology*
  • Young Adult