Prognostic indicators of low back pain in primary care: five-year prospective study

J Pain. 2013 Aug;14(8):873-83. doi: 10.1016/j.jpain.2013.03.013. Epub 2013 Jun 20.


Back pain is common and many people experience long-term problems, yet little is known about what prognostic factors predict long-term outcomes. This study's objective was to determine which factors predict short- and long-term outcomes in primary care consulters with low back pain (LBP). Analysis was carried out on 488 patients who had consulted their physician about LBP. Patients were followed up at 6 months and 5 years. Clinically significant LBP at follow-up was defined as a score of 2, 3, or 4 on the Chronic Pain Grade, indicating substantial pain and disability. Cox regression was used to estimate relative risks (RRs) with 95% confidence intervals (CIs) on 32 potential predictive factors, organized into domains (demographic, physical, psychological, and occupational). Baseline pain intensity conferred a 12% increase in risk (RR = 1.12, 95% CI = 1.03-1.20), and patients' belief that their LBP would persist conferred a 4% increase in risk (RR = 1.04, 95% CI = 1.01-1.07) for poor outcome at 6 months. Outcome at 5 years was best predicted by a model with the same factors as in the 6-month model: pain intensity increased risk by 9% (RR = 1.09, 95% CI = .997-1.20), and a belief that their LBP would persist increased risk by 6% (RR = 1.06, 95% CI = 1.03-1.09). Both predictors have the potential to be targets for clinical intervention.

Perspective: Few studies have investigated factors that predict long-term back pain. This study has shown that pain intensity experienced during a period of primary care consultation, and patients' perception about whether their back pain will persist, were significant predictors of poor outcome at 6 months and at 5 years.

Keywords: Prognosis; cohort; longitudinal; low back pain; prospective.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Disability Evaluation
  • Female
  • Humans
  • Longitudinal Studies
  • Low Back Pain / diagnosis*
  • Low Back Pain / epidemiology
  • Low Back Pain / psychology
  • Low Back Pain / therapy*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Occupations
  • Outcome Assessment, Health Care
  • Pain Measurement
  • Predictive Value of Tests
  • Primary Health Care*
  • Prognosis
  • Psychological Tests
  • Surveys and Questionnaires
  • Time Factors
  • Young Adult