Risk factors for chronicity

It is important to identify early those low back pain patients at risk for long-term disability and sick leave, because early and specific interventions may be developed and used in this subgroup of patients. As stated before, most patients are likely to recover within a couple of days or weeks, but recovery for those who develop chronic low back pain and disability becomes increasingly less likely the longer the problems continue. The small group of patients with long-term severe low back pain also account for substantial healthcare utilization and sick leave, and associated costs.

Evidence suggests that psychosocial factors are important in the transition from acute to chronic low back pain and disability [19]. A systematic review of prospective cohort studies found that some psychologic factors (distress, depressive mood, and somatization) are associated with an increased risk of chronic low back pain [22].

Individual and workplace factors, such as job dissatisfaction, low educational level, and high levels of pain and disability, have also been reported to be associated with the transition to chronic low back pain [23, 24]. A prospective cohort study found that severe leg pain, obesity, functional disability, poor general health status, unavailability of light duties on return to work, and a job requirement of lifting for three-fourths of the day or more were associated with the transition from acute to chronic occupational back pain [25]. Job dissatisfaction or poor workplace relations were not associated with chronic low back pain [25]. Another prospective cohort study of 328 employees identified prognostic factors for return to work of employees with 3-4 months sick leave due to low back pain [26]. Risk factors included poor general health status, low job satisfaction, not being a bread winner, lower age and higher pain intensity. The authors concluded that psychosocial aspects of health and work in combination with economic aspects have a significantly larger impact on return to work when compared to relatively more physical aspects of disability and physical requirements of the job [26].

The transition from acute to chronic low back pain seems complicated and many individual, psychosocial and workplace factors may play a role. As the identification of patients at risk of chronicity will depend on identification of these factors, the implication for clinical management is still unclear. Although psychosocial yellow flags are at present expected to play an important role in screening of high-risk patients with acute and subacute low back pain [27] and a screening instrument has been suggested for use in clinical practice [28], future research is definitely needed to test the predictive value of these factors and instruments in clinical practice.

Back Pain Relief

Back Pain Relief

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