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Getting Beyond Guesswork in Predicting the Course of Low Back Pain

Low back pain is tricky to treat. For some patients, low back pain goes away on its own. Other patients never get better, forcing them to quit their jobs. Doctors would love to be able to predict which of their patients will have the hardest time returning to their jobs. That would allow the health care team to create a treatment plan designed to help patients get back to work. The savings in health care, lost days of work, and workers' compensation insurance would be substantial.

Many researchers have tried to identify tests that help doctors predict the outcomes of low back pain--without much success. But these authors seem to be onto something. They worked with 253 patients with low back pain. All the patients had been out of work for at least four weeks because of a low back injury at work. All were covered under the workers' compensation system in Canada. The patients went through a series of physical tests. Doctors also noted how they reacted to pain. The patients filled out surveys about their general health, home and work life, depression, anxiety, and pain. The same tests and surveys were repeated after three days and again after three months.

The authors found several factors that were related to the patients' ability to return to work:

  • patients' opinions about their general health
  • patients' attitudes about whether they would be able to work again
  • fear of job loss
  • sciatica (pain down the leg)
  • time to walk a set distance
  • excessive "guarding" of the hurt area from further pain

    Using these factors, this model was over 80 percent accurate in predicting who would return to work, and it was 75 percent accurate in predicting who would not be able to return to work. These are good results for this type of model.

    More research is needed to figure out how this model could be actually be used by doctors. However, these authors do note some findings that could help doctors and patients right now. For example, fear of job loss and an attitude that returning to work might be impossible made people less likely to go back to their jobs. If doctors, therapists, patients, and employers could work together to modify work tasks, those fears and attitudes could be changed.

    The authors emphasize that most of the predictive factors were based in patients' beliefs. They stress that any measure of low back pain needs to include an understanding of the patients' attitudes, fears, and work and home situations.


    Izabela Z. Schultz, PhD, et al. Biopsychosocial Multivariate Predictive Model of Occupational Low Back Disability. In Spine. December 1, 2002. Vol. 27. No. 23. Pp. 2720-2725.

    01/14/2003

    *Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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