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Cited by 533Musculoskeletal pain and rehabilitationPain Mechanisms and TreatmentsSpine and Intervertebral Disc Pathology

Report of the NIH Task Force on research standards for chronic low back pain.

Open access
Deyo, Richard A., Dworkin, Samuel F., Amtmann, Dagmar, Andersson, Gunnar, Borenstein, David, Carragee, Eugene, Carrino, John, Chou, Roger +12 more·2014·The Journal of Pain
DOI 10.1016/j.jpain.2014.03.005PMC PMC4128347
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Abstract

Unlabelled Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed non-specific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. Therefore, NIH Pain Consortium charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimum dataset to describe research participants (drawing heavily on the PROMIS methodology); reporting "responder analyses" in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals. The RTF believes that these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. We expect that the RTF recommendations will become a dynamic document and undergo continual improvement.Perspective A task force was convened by the NIH Pain Consortium with the goal of developing research standards for chronic low back pain. The results included recommendations for definitions, a minimum dataset, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes.

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Crossref · 10.1016/j.jpain.2014.03.005

Cites

130 of 130 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 44 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In the validation sample, baseline RTF Impact scores were almost equally distributed among mild, moderate, and severe impact categories.

    “In this rather severely affected sample, baseline RTF Impact scores were almost equally distributed among mild, moderate and severe impacts.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Changes in RTF Impact Stratification scores correlated more strongly with patient satisfaction at follow-up than changes in the Roland-Morris score did.

    “Furthermore, score changes on the RTF Impact Stratification correlated more strongly with patient satisfaction at follow-up than did change on the Roland-Morris score (Table 5).”
    Quote in the paperSubstantial claim
  • Findingown data

    Based on effect size and standardized response mean at 3-month follow-up, the RTF Impact Stratification was more responsive than the Roland-Morris Disability Scale.

    “Measures of effect size and standardized response mean for the 170 patients available for 3-month follow-up suggested that the RTF Impact Stratification was more responsive than the Roland-Morris Disability Scale (Table 3).”
    Quote in the paperSubstantial claim
  • Findingown data

    In the RTF survey, the highest-ranked medical history and examination items for a minimal dataset included demographics, workers' compensation or legal claims, work status, education, comorbidity measures, and previous treatment history.

    “In the survey of RTF members regarding items for a minimal dataset, the most highly ranked items of medical history and examination included demographics, involvement in workers’ compensation or legal claims, work status, education, various measures of comorbidity, and previous treatment history.”
    Quote in the paperSubstantial claim
  • Findingown data

    Physical examination measures ranked lower than medical history items in the RTF survey.

    “Measures from the physical examination ranked lower than items of medical history.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 13
  • Classified as probably not a substantial claim. 17
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    The validation sample included 218 patients with a mean age of 54 years, and 56% were female.

    “The sample included 218 patients with a mean age of 54 years; 56% were females.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    The key comorbid conditions selected for the minimal dataset were smoking status, obesity, substance abuse, and widespread pain symptoms.

    “The key comorbid conditions were judged to be smoking status, obesity, substance abuse, and widespread pain symptoms.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In an internet survey of 221 back pain patients, the median time to complete the recommended Minimal Dataset was 7 minutes, and 75% finished in under 10 minutes.

    “In this sample, the median time-to-completion was 7 minutes, and 75% of subjects completed the questionnaire in less than 10 minutes.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Scores on the Impact Stratification measure improved over time in the validation sample.

    “Scores on the Impact Stratification measure for this sample improved over time, as expected.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Given the epidural steroid injection intervention, an improvement in average functional scores was expected.

  • May combine two claims.

    Findingown data

    The highest-ranked physical examination items were straight leg raising for patients with leg pain, hip internal rotation as a screen for hip arthritis, and lower extremity strength.

    “However, the most highly ranked of these were straight leg raising for patients with leg pain; hip internal rotation as a screen for hip arthritis (a potential cause of LBP); and lower extremity strength.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Chronic low back pain is often non-specific and may arise from multiple biologic and behavioral causes that differ across individuals.

    “Such cLBP is often termed non-specific, and may be due to multiple biologic and behavioral etiologies.”
    • Also stated in: § Perspective · hedged
      “may in fact be due to the contributions of different and multiple biologic and behavioral etiologies in different individuals.87”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [87] Negrini, 2013, The chimera of low back pain etiology: a clinical rehabilitation perspective, Am J Phys Med Rehabil source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Despite rising intervention rates, functional disability from chronic low back pain has worsened in recent decades, and symptom prevalence and expenditures have also increased.

    “Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades.”
    • Also stated in: § Perspective · plain
      “Despite increased utilization, however, the prevalence of symptoms and expenditures has increased.37, 70, 91”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [37] Deyo, 2009, Overtreating chronic back pain: time to back off?, J Am Board Fam Med source

      Not checked in the free run.

    • cites [70] Kenan, 2012, Trends in prescriptions for oxycodone and other commonly used opioids in the United States, 2000-2010, Open Med

      Not checked in the free run.

    • cites [91] Rajaee, 2012, Spinal fusion in the United States: analysis of trends from 1998 to 2008, Spine (Phila Pa 1976) source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Many interventions for chronic low back pain produce some clinical benefit, but few consistently yield substantial long-term pain reduction with improved function.

    “Many of these have shown some clinical benefit, but few appear to consistently provide substantial, long-term reductions in pain with increased function.25, 27–29”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [25] Chou, 2009, Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline, Spine (Phila Pa 1976) source

      Not checked in the free run.

    • cites [27] Chou, 2007, Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline, Ann Intern Med source

      Not checked in the free run.

    • cites [28] Chou, 2007, Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline, Ann Intern Med source

      Not checked in the free run.

    • cites [29] Chou, 2009, Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society, Spine (Phila Pa 1976) source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Because of inconsistent methods across studies, it is difficult to compare epidemiological data and intervention studies, replicate findings, pool data, resolve conflicting conclusions, and reach multidisciplinary or within-discipline consensus on interpretation.

    “As a result, it is difficult to compare epidemiological data and studies of similar or competing interventions, replicate findings, pool data from multiple studies, resolve conflicting conclusions, develop multidisciplinary consensus, or even achieve consensus within a discipline regarding interpretation of findings.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The reported analyses of the impact stratification strategy represent only an initial assessment.

    “The Task Force found the results encouraging but acknowledges that the analyses reported reflect only an initial assessment.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Stratifying chronic low back pain by impact would be appropriate regardless of whether contributory degenerative pathoanatomy appears to be present.

    “This stratification of cLBP by impact would be appropriate whether or not there appears to be contributory degenerative pathoanatomy.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Even when pathoanatomic conditions are thought to contribute to symptoms and dysfunction, they often coexist and overlap, and sometimes fail to respond to specific interventions.

  • Classified as probably not a substantial claim.

    Interpretationnone given

    The task force identified several knowledge gaps that limit the ability to define and classify critical domains and variables.

    “Beyond viewing the present set of recommendations as appropriate topics for future research, the RTF identified several related knowledge gaps that limit our ability to define and classify critical domains and variables.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The RTF could not address every part of the NIH Pain Consortium's charge; for example, producing explicit evidence-based diagnostic criteria for spinal stenosis, sciatica, or spine instability was impossible given available time, resources, and the lack of professional consensus.

    “The RTF decided that it could not respond in detail to every component of the NIH Pain Consortium’s charge. For example, producing explicit evidence-based diagnostic criteria for conditions such as spinal stenosis, sciatica, or spine “instability” would be impossible with available time and resources, given the current lack of professional consensus.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationnone given

    Stratifying chronic low back pain by impact might have descriptive and prognostic value comparable to pathophysiologic description and could supplement it.

    “However, stratifying cLBP by its impact might have equally important descriptive and prognostic value, and could supplement any pathophysiologic description.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The two-item conjoint scale (TICS) is an adequate and suitably brief screen for substance abuse.

    “The two-item conjoint scale (TICS) was judged to be an adequate and suitably brief screen for substance abuse.18”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] Brown, 2001, A two-item conjoint screen for alcohol and other drug problems, J Am Board Fam Pract

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Creating an impact stratification and a uniform minimal dataset will achieve many of the same goals as research diagnostic criteria.

    “However, creation of an impact stratification and a uniform minimal dataset will achieve many of the same goals.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    The likely adverse events of an intervention vary greatly with the nature of that intervention.

    “Because the likely adverse events vary enormously with the nature of an intervention, the RTF did not make recommendations for reporting specific adverse events.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Because data on the performance of composite outcome measures for low back pain are scarce, the task force could not recommend them.

    “However, the RTF concluded that with the paucity of data on performance of such composite measures for low back pain, it could not make a recommendation about composite outcome measures.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    The RTF agreed that neither adequate data nor resources were available to create a new pathoanatomic or pathophysiologic subclassification of chronic low back pain that was clearly superior to existing ones.

    “The RTF overwhelmingly agreed that neither adequate data nor resources were available to offer a new pathoanatomic or pathophysiologic subclassification of cLBP that was clearly superior to those currently available.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Many patients who undergo procedures intended to correct putative causative pathoanatomy continue to have pain.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Impact stratification is a useful addition to pathoanatomic, physiologic, or symptomatic classification, but it is not a substitute for those approaches.

    “Thus, the stratification of impact seems to be a useful addition to pathoanatomic, physiologic, or symptomatic classification, but not a substitute.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Even when pathoanatomic conditions are thought to contribute to symptoms and dysfunction, they often coexist and overlap, and sometimes fail to respond to specific interventions.

  • May combine two claims.

    Premisecitation

    Although the PROMIS measures have been extensively validated, there is only modest information about their performance specifically in chronic low back pain.

    “Extensive effort has been made to validate the PROMIS measures,5, 7, 21, 51, 55, 72, 89, 92, 95 but there is modest information on their performance specifically in the context of cLBP.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [5] Amtmann, 2010, Development of a PROMIS item bank to measure pain interference, Pain source

      Not checked in the free run.

    • cites [7] Askew, 2013, Development of a crosswalk for pain interference measured by the BPI and PROMIS pain interference short form, Qual Life Res source

      Not checked in the free run.

    • cites [21] Buysse, 2010, Development and validation of patient-reported outcome measures for sleep disturbance and sleep-related impairments, Sleep source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    The new research standards should improve comparability of chronic low back pain studies, facilitate pooling of data across studies, and improve the ability to define phenotypes.

    “The new research standards should improve the comparability of research studies on cLBP, facilitate pooling data from multiple studies (e.g., for meta-analyses), and improve the ability to define phenotypes among patients with low back pain.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Widespread use of the minimal dataset will provide accumulating evidence for or against the reliability, validity, and clinical utility of the task force recommendations.

    “Because the measures in the minimal dataset will often not comprise the sole measures used in a study, their widespread use will not only provide researchers a standardized set of data, but will also provide accumulating evidence for (or against) the reliability, validity, and clinical utility of the RTF recommendations.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The appropriate timing of outcome assessments depends on the intervention being studied.

    “The RTF chose not to make specific recommendations for timing of outcome assessments because appropriate timing would vary depending on an intervention.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    These standards will allow comparable core summary statistics to be included in all published reports without interfering with the collection of specific measures needed for specific research questions.

    “These standards will allow comparable core summary statistics to be included in all published reports, without interfering with collection of specific measures needed to address specific research questions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The validation analysis was covered by an existing Institutional Review Board approval from the University of Washington.

    “This analysis was covered by an existing Institutional Review Board approval from the University of Washington.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Other researchers have systematically reviewed risk factors for the emergence of chronic back pain.

    “and others have systematically reviewed risk factors for the emergence of chronic back pain.30”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Chou, 2010, Will this patient develop persistent disabling low back pain?, JAMA source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The short-form PROMIS measures provide the best balance between brevity and psychometric validity for a minimal dataset.

    “After considering several potential instruments for assessing these domains, the RTF concluded that the short-form PROMIS measures1 offered the best trade-off of length with psychometric validity for a minimal dataset.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] Accessing PROMIS Short Form Instruments. Available at: http://www.assessmentcenter.net/PromisForms.aspx. Accessed February 2, 2014

      Not checked in the free run.

    • cites [22] Cella, 2010, The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008, J Clin Epidemiol source

      Not checked in the free run.

28 of 28

  • The paper relies on this without support.

    Many patients who undergo procedures intended to correct putative causative pathoanatomy continue to have pain.

    “Many patients who undergo procedures intended to correct the putative causative pathoanatomy continue to have pain.”

  • The authors state this as an assumption.

    Given the epidural steroid injection intervention, an improvement in average functional scores was expected.

    “Given the intervention, an improvement in average functional scores was expected.”

  • The paper relies on this without support.

    Even when pathoanatomic conditions are thought to contribute to symptoms and dysfunction, they often coexist and overlap, and sometimes fail to respond to specific interventions.

    “Even when pathoanatomic conditions are thought to contribute to symptoms and dysfunction, they often coexist and overlap, and sometimes fail to respond to specific interventions.”

  • The paper relies on this without support.

    In older adults, hip osteoarthritis is more likely to contribute to low back pain.

    “In older adults, there is increased likelihood of hip osteoarthritis contributing to low back pain.”

  • The paper relies on this without support.

    Dementia may impair the validity of assessments or of consent for research.

    “A screen for cognitive function may also be important in such studies, as dementia may impair the validity of assessments or of consent for research.”

  • The paper relies on this without support.

    Little work has addressed the outcomes that patients with chronic low back pain judge most important.

    “little work has addressed the outcomes judged most important by patients with chronic low back pain.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • The three-month boundary differs between the definition and its questions

    Minor

    The stated definition includes a back-pain problem lasting exactly three months, but the specified response to question 1 requires more than three months. A person at the three-month boundary would therefore qualify under one statement but not the other.

1 of 1

Cites

Flagged first, then by citations

2 of the 132 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Keefe FJ, Williams DA, Smith SJ: Assessment of pain behaviors, in Turk DC, Melzack R (ed): Handbook of Pain Assessment, New York, NY, Guilford Press, 2001, pp 170-190

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Authors
Deyo, R. A., Dworkin, S. F., Amtmann, D., Andersson, G., Borenstein, D., Carragee, E., Carrino, J., Chou, R., Cook, K., DeLitto, A., Goertz, C., Khalsa, P., Loeser, J., Mackey, S., Panagis, J., Rainville, J., Tosteson, T., Turk, D., Von Korff, M., & Weiner, D. K.
Affiliations
  • Oregon Health & Science University (US)
  • University of Washington (US)
  • Rush University Medical Center (US)
  • George Washington University (US)
  • Stanford University (US)
  • Johns Hopkins University (US)
  • Northwestern University (US)
  • University of Pittsburgh (US)
  • Palmer College of Chiropractic (US)
  • National Center for Complementary and Integrative Health (US)
  • National Institutes of Health (US)
  • New England Baptist Hospital (US)
  • Dartmouth College (US)
Corresponding author
Deyo, Richard A.
ORCID
Venue
The Journal of Pain
Publisher
Elsevier BV
Published
2014-06
Volume
15
Issue
6
Pages
569-585
ISSN
1526-5900 (ISSN-L)
DOI
10.1016/j.jpain.2014.03.005
PMC
PMC4128347
OpenAlex
W2089675869
Cited by
533
References
132
Citations by year
2026: 34 · 2025: 60 · 2024: 44 · 2023: 50 · 2022: 50 · 2021: 67 · 2020: 59 · 2019: 43 · 2018: 48 · 2017: 24 · 2016: 32 · 2015: 18 · 2014: 3 · 2013: 1
FWCI
18.65
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Pain (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (Z99 AT999999, Z99 AR999999)
  • National Cancer Institute (P30CA023108)
  • National Institute of Nursing Research
  • National Center for Complementary and Alternative Medicine
  • National Institute of Neurological Disorders and Stroke
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases
  • National Institute of Child Health and Human Development
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
Keywords
chronic low back pain, non-specific low back pain, research standards, minimum dataset, PROMIS, responder analysis, outcome reporting, pain interference, physical function, phenotypes, functional disability
MeSH terms
Humans, National Institutes of Health (U.S.), Pain Measurement, Research, Research Design, United States, Low Back Pain, Advisory Committees, Chronic Pain

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