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Cited by 199Musculoskeletal pain and rehabilitationPain Management and TreatmentSpine and Intervertebral Disc Pathology

A prognostic approach to defining chronic pain

Von Korff, Michael, Miglioretti, Diana L.·2005·Pain
DOI 10.1016/j.pain.2005.06.017
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Abstract

This paper develops a prognostic approach to defining chronic back pain. Possible and probable chronic back pain were defined, respectively, by a 50% and an 80% (or greater) probability of future clinically significant back pain. We assessed whether an empirically derived chronic pain classification satisfied these validating criteria among 1213 primary care back pain patients assessed at baseline and at 1, 2 and 5 year follow-ups. From multiple measures of back pain intensity and dysfunction, Latent Transition Regression Analysis empirically identified four pain severity latent classes: no pain; mild pain; moderate pain and limitation; and severe, limiting pain. From one observation point to the next, patients were most likely to remain in the same pain severity class, but chronic pain was better characterized as a dynamic state than a static trait. Among persons with severe, limiting pain, prognostic variables (depression, diffuse pain, pain persistence) improved prediction of future severe, limiting pain. A risk score developed from pain severity and prognostic measures identified risk levels corresponding to 50 and 80% probability thresholds for predicting future clinically significant back pain. At baseline and 1 year, 6.1 and 4.4% of study patients met or exceeded the 80% risk threshold for probable chronic back pain. An additional 20.3% at baseline and 12.5% at 1 year met or exceeded the 50% risk threshold for possible chronic back pain. Defining chronic pain prospectively, by risk thresholds for future clinically significant pain, provides an empirically grounded approach to chronic pain assessment.

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Crossref · 10.1016/j.pain.2005.06.017

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  • Definitions based solely on pain duration do not consider the multidimensional nature of chronic pain, namely activity limitations and participation restrictions.

    “Although conceptually appealing, this hotly debated7 approach does not consider the multidimensional nature of chronic pain, namely, the presence of activity limitations and participation restrictions,5,17,30–36 classifications recognized by the World Health Organization.37”

    From Prevalence and Profile of High-Impact Chronic Pain in the United States (2019) · cites this paper as [34]

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Related

Authors
Von Korff, M., & Miglioretti, D. L.
Affiliations
Group Health Cooperative (US)
ORCID
Miglioretti, Diana L.
Venue
Pain
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2005-10
Volume
117
Issue
3
Pages
304-313
ISSN
0304-3959 (ISSN-L)
DOI
10.1016/j.pain.2005.06.017
OpenAlex
W1983314768
Cited by
199
References
20
Citations by year
2026: 2 · 2025: 4 · 2024: 6 · 2023: 5 · 2022: 9 · 2021: 5 · 2020: 7 · 2019: 10 · 2018: 12 · 2017: 15 · 2016: 7 · 2015: 10 · 2014: 18 · 2013: 20 · 2012: 5
FWCI
5.95
Type
journal article
Language
en
Open access
closed
Locations
  • Pain (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • National Institute of Dental and Craniofacial Research (P01 DE08773, P01DE008773)
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
Keywords
chronic back pain, prognostic thresholds, pain persistence, depression, diffuse pain, risk score, primary care patients
MeSH terms
Adolescent, Adult, Aged, Chronic Disease, Disability Evaluation, Female, Humans, Interviews as Topic, Male, Middle Aged, Pain, Pain Measurement, Predictive Value of Tests, Probability, Prognosis, Regression Analysis, Risk, Severity of Illness Index

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