Stages of Low Back Pain Have Specific Sets of Clinical Indicators

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A total of 35,446 patients with chronic low back pain were asked to fill out an epidemiologic questionnaire as well as 7 clinical questionnaires.
A total of 35,446 patients with chronic low back pain were asked to fill out an epidemiologic questionnaire as well as 7 clinical questionnaires.

Burning and prickling sensations, in addition to pressure pain and pain attacks, may serve as indicators of chronicity in low back pain, according to a study published in Pain Practice.

A total of 35,446 patients with chronic low back pain were asked to fill out an epidemiologic questionnaire and 7 clinical questionnaires to assess disability (Pain Disability Index), the ability to perform activities (Hannover Functional Questionnaire), the risk for developing chronic low back pain (Heidelberg short Questionnaire), and mental health (Patient Health Questionnaire and Generalized Anxiety Disorders).

Study participants with chronic vs acute/subacute low back pain were older (P <.001), and elderly patients (ie, >65 years) vs those <65 years indicated higher levels of pain for acute (vs 58.46 ±20.2) vs 52.03±21.01, respectively; P <.0001]), subacute low back pain (58.98±20.48 vs 56.16±19.14; P =.017]), and chronic low back pain (58.08±19.13 vs 57.42±18.89; P =.0068).

Women reported higher current, average, and maximum pain intensity compared with men, with an additional 3 to 4 points on the visual analog scale on average in the acute stage (P <.001 for all), an additional 1.5 to 4 extra points on average during subacute low back pain (P <.001 for current and average pain intensity), and an additional 2 to 3 points for chronic low back pain (P <.001 for all).

In addition, patients with chronic low back pain had higher neuropathic pain scores compared with patients in subacute and acute stages (13.2±7.1 vs 11.6±6.7 and 10.7±6.4, respectively; P <.0001 for all). In all participants, the pain descriptors most commonly used were pain attacks and pressure pain for all stages of low back pain, followed by “burning” and “prickling” were most commonly reported by those with chronic low back pain.

The ability to diagnose low back pain based on the International Statistical Classification of Diseases and Related Health Problems, tenth edition criteria, was available for only 10% of patients, potentially resulting in misclassification of some of the study participants.

“It is important to improve the understanding of pain mechanisms with regard to different chronicity stages as well as their impact on sociodemographical and epidemiological aspects,” concluded the study authors.

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Reference

Hüllemann P, Keller T, Kabelitz M, et al. Clinical manifestation of acute, subacute and chronic low back pain in different age groups [published online April 30, 2018]. Pain Pract. doi: 10.1111/papr.12704

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