Thanks to Norton et al for “Classification of patients with incident nonspecific low back pain: implications for research” that appears in “spine”
Four distinct groups of patients were identified and validated. One group (53.4%) of patients recovered immediately. One third of patients (31.7%) may appear to recover over six months, but maintain a 37-48% likelihood of receiving care for low back pain in every subsequent quarter, implying frequent relapse. Two remaining groups of patients each maintain very high probabilities of receiving care in every quarter (65-78% and 84-90%), predominantly utilizing therapeutic services and pain medication, respectively. Probabilistic grouping relative to alternatives was very high (89.6-99.3%). Grouping was not related to demographic or clinical characteristics.
The four distinct sets of patient experiences have clear implications for research. Inclusion criteria should specify incident or recurrent cases. A six-month clean period may not be sufficiently long to assess incidence. Reporting should specify the proportion recovering immediately to prevent mean recovery rates from masking between-group differences. Continuous measurement of pain or disability may be more reliable than measuring outcomes at distinct endpoints.
Deyo, R.A., et al., Report of the NIH task force on research standards for chronic low back pain. Spine J, 2014. 39(14): p. 1128-43.
Stanton, T.R., et al., A modified Delphi approach to standardize low back pain recurrence terminology. Eur Spine J, 2011. 20(5): p. 744-52.
Kamper, S.J., et al., How is recovery from low back pain measured? A systematic review of the literature. Eur Spine J, 2011. 20(1): p. 9-18.
de Vet, H.C., et al., Episodes of low back pain: a proposal for uniform definitions to be used in research. Spine, 2002. 27(21): p. 2409-2416.
Hoy, D., et al., The Epidemiology of low back pain. Best Pract Res Clin Rheumatol, 2010. 24(6): p. 769-81.
Tosteson, A.N.A., et al., Comparative effectiveness evidence from the spine patient outcomes research trial: surgical versus nonoperative care for spinal stenosis, degenerative spondylolisthesis, and intervertebral disc herniation. Spine, 2011. 36(24): p. 2061-8.
Radcliff, K., et al., The impact of epidural steroid injections on the outcomes of patients treated for lumbar disc herniation: a subgroup analysis of the SPORT trial. J Bone Joint Surg Am, 2012. 94(15): p. 1353-8.
Lurie, J.D., et al., Magnetic Resonance Imaging Predictors of Surgical Outcome in Patients With Lumbar Intervertebral Disc Herniation. Spine, 2013. 38(14): p. 1216–1225.
Indrakanti, S.S., Value-based Care in the Management of Spinal Disorders: A Systematic Review of Cost-utility Analysis. Clin Orthop Relat Res, 2012. 470(4): p. 1106-1123.
Freburger, J.K., et al., The rising prevalence of chronic low back pain. Arch Intern Med, 2009. 169(3): p. 251-8.
Costa, L.d.C.M., et al., The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ, 2012. 184(11): p. E613-E624.
Heuch, I. and I.S. Foss, Acute low back usually resolves quickly but persistent low back pain often persists. [12 mo]. J Physiother, 2013. 59(2): p. 127.
Tamcan, O., et al., The course of chronic and recurrent low back pain in the general population. Pain, 2010. 150(3): p. 451-7.
Foster, N.E., Barriers and progress in the treatment of low back pain. BMC Med, 2011. 9: p. 108.
Axen, I., et al., Clustering patients on the basis of their individual course of low back pain over a six month period. BMC Musculoskelet Disord, 2011. 12: p. 99.
Dunn, K.M., K. Jordan, and P.R. Croft, Characterizing the course of low back pain: a latent class analysis. Am J Epidemiol, 2006. 163(8): p. 754-61.
Von Korff, M.-. Studying the natural history of back pain. Spine, 1994. 19(18 Suppl): p. 2041S-2046S.
Ivo, R., et al., Brain structural and psychometric alterations in chronic low back pain. Eur Spine J, 2013. 22(9): p. 1958-1964.
Bushnell, M.C., M. Ceko, and L.A. Low, Cognitive and emotional control of pain and its disruption in chronic pain. Nat Rev Neurosci, 2013. 14(7): p. 502-11.
Cassidy, J.D., et al., Incidence and course of low back pain episodes in the general population. Spine, 2005. 30(24): p. 2817-23.
Carragee, E., et al., Are first-time episodes of serious LBP associated with new MRI findings? Spine J, 2006. 6(6): p. 624-35.
Sinnott, P.L., et al., Identifying neck and back pain in administrative data: defining the right cohort. Spine, 2012. 37(10): p. 860-74.
Vogt, M.T., et al., Analgesic usage for low back pain: impact on health care costs and service use. Spine, 2005. 30(9): p. 1075-1081.
Kominski, G.F., et al., Economic evaluation of four treatments for low-back pain: results from a randomized controlled trial. Med Care, 2005. 43(5): p. 428-35.
Martin, B.I., et al., Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures. Spine, 2007. 32(3): p. 382-387.
Hoogendoorn, W., et al., High physical work load and low job satisfaction increase the risk of sickness absence due to low back pain: results of a prospective cohort study. Occup. Environ. Med, 2002. 59(5): p. 323-328.
Skouen, J.S., et al., Relative cost-effectiveness of extensive and light multidisciplinary treatment programs versus treatment as usual for patients with chronic low back pain on long-term sick leave: randomized controlled study. Spine, 2002. 27(9): p. 901-909.
Cherkin, D.C., R.A. Deyo, and J.D. Loeser, Use of the International Classification of Diseases (ICD-9-CM) to identify hospitalizations for mechanical low back problems in administrative databases. Spine, 1992. 17(7): p. 817-825.
Mental Health: A Report of the Surgeon General, 1999, Substance Abuse and Mental Health Services Administration and the National Institute of Mental Health, U.S. Department of Health and Human Services: Rockville, MD.
Adams, J.R. and R.E. Drake, Shared decision-making and evidence-based practice. Community Ment Health J, 2006. 42: p. 87-105.
Lanza, S.T., et al., PROC LCA: A SAS Procedure for Latent Class Analysis. Struct. Equ. Modeling, 2007. 14(4): p. 671-694.
Mafi, J.N., et al., Worsening Trends in the Management and Treatment of Back Pain. JAMA Internal Medicine, 2013. 173(17): p. 1573-1581.
Landon, B.E., et al., The relationship between physician compensation strategies and the intensity of care delivered to Medicare beneficiaries. HSR, 2011. 46(6pt1): p. 1863-82.
Hughes, D.R., M. Bhargavan, and J.H. Sunshine, Imaging Self-Referral Associated With Higher Costs And Limited Impact On Duration Of Illness. Health Affair, 2010. 29(12): p. 2244-2250.
Lanza, S.T., et al., Proc LCA & Proc LTA user’s guide (Version 1.3.0), 2013, The Pennsylvania State University: University Park: The Methodology Center.
Buchbinder, R. and M. Underwood, Prognosis in people with back pain (Commentary). CMAJ, 2013. 185(4): p. 325.
Ritzwoller, D.P., et al., The association of comorbidities, utilization and costs for patients identified with low back pain. BMC Musculoskelet Disorders, 2006. 7: p. 72-81.
Wasiak, R., et al., Back Pain Recurrence: An Evaluation of Existing Indicators and Direction for Future Research. Spine, 2009. 34(9): p. 970-977.
Lemeunier, N., A. Kongsted, and I. Axen, Prevalence of pain-free weeks in chiropractic subjects with low back pain – a longitudinal study using data gathered with text messages. Chiropr Man Therap, 2011. 19: p. 28.
Tyree, P.T., B.K. Lind, and W.E. Lafferty, Challenges of Using Medical Insurance Claims Data for Utilization Analysis. Am J Med Qual, 2006. 21(6): p. 269-275.
Croft, P.R., et al., Outcome of low back pain in general practice: a prospective study. BMJ, 1998. 316: p. 1356-1360.
Riley, G.F., Administrative and claims records as sources of health care cost data. Med Care, 2009. 47(7 Suppl 1): p. S51-5.
Wingert, T.D., et al., Constructing episodes of care from encounter and claims data: some methodological issues. Inquiry, 1995. 32(4): p. 430-43.
van Hooff, M.L., et al., Predictive factors for successful clinical outcome 1 year after an intensive combined physical and psychological programme for chronic low back pain. Eur Spine J, 2013. 23(1): p. 102-112.