Chronic Low Back Pain With Chronic Overlapping Pain Conditions Linked to Unfavorable Outcomes

Patients with combined chronic low back pain and chronic overlapping pain conditions have significantly worse psychological, physical, social, and global health outcomes compared with individuals with chronic low back pain alone, according to study findings published in Pain Practice.

For the analysis, researchers conducted a cross-sectional study using demographic, legacy survey, and patient data collected from the Patient-Reported Outcomes Measurement Information System (PROMIS).

These data were used to characterize the physical, psychological, social, and global health outcomes of each of the 2 categories of patients. Those in the group with COPCs were further divided into intermediate and severe pain subgroups depending on how many body regions were affected by pain. Descriptive statistics and generalized linear regression models were used to characterize and compare the groups.

The study evaluated data collected from 8783 patients with chronic low back pain, of which 485 (5.5%) had local pain that was not widespread. Compared with this group, those in the group with widespread pain associated with COPCs were more likely to be women (77.6% vs 59.0%), younger (51.7 vs 58.4 years), and report a longer duration of pain (7.4 vs 5.7 years).

Data analysis revealed that those with widespread pain had worse outcomes in physical, mental, social, and global health. Outcomes with large clinical differences between groups included fatigue, sleep impairment and disturbance, pain behavior, physical function, pain interference, and anxiety. Adjustment that controlled for age, sex, body mass index category, and duration of pain confirmed that all outcomes were worse in the group with widespread pain than in the group with local pain.

On the basis of these findings, the researchers concluded that COPCs commonly accompany chronic lower back pain and are associated with considerably worse physical, psychological, social, and global health outcomes than the outcomes that result from local chronic low back pain.

“[D]etecting this group of patients with COPCs can be easily and rapidly identified using a body map and validated patient-reported outcome measures,” the study authors wrote. “Identifying and characterizing this population of patients with COPCs can support the development of improved risk and treatment stratification paradigms for this group.”

Study limitations include using a cross-sectional data registry and enrolling patients from a single tertiary referral pain center, which limits the generalizability of results to a primary care population. Moreover, the researchers did not control for underlying pathology.