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

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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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Additional file 1 of Classifying patients with non-specific chronic low back pain using the impact stratification score in an online convenience sample
Rodriguez, A., Herman, P. M., Slaughter, M. E., Edelen, M. O., & Hays, R. D. (2023) · Figshare · doi:10.6084/m9.figshare.24114971
Additional file 1 of Association between chronic low back pain and regular exercise, sedentary behaviour and mental health before and during COVID-19 pandemic: insights from a large-scale cross-sectional study in Germany
Hochheim, M., Ramm, P., Wunderlich, M., & Amelung, V (2022) · Figshare · doi:10.6084/m9.figshare.21117194
Additional file 3 of Chronic temporomandibular disorder pain patients with a history of neuropathic pain treatment: a narrative research on their diagnosis and treatment history
Baggen, J. H. M., Koevoets, A. C., Koutris, M., Steegers, M. A. H., & Lobbezoo, F. (2024) · Figshare · doi:10.6084/m9.figshare.26661221
Additional file 1 of Can the French version of the short Örebro Musculoskeletal Pain Screening Questionnaire or its subsets predict the evolution of patients with acute, (sub) acute and chronic pain?
Korogod, N., Steyaert, A., Nonclercq, O., Opsommer, E., & Berquin, A. (2022) · Figshare · doi:10.6084/m9.figshare.19498377
Additional file 1 of Chronic temporomandibular disorder pain patients with a history of neuropathic pain treatment: a narrative research on their diagnosis and treatment history
Baggen, J. H. M., Koevoets, A. C., Koutris, M., Steegers, M. A. H., & Lobbezoo, F. (2024) · Figshare · doi:10.6084/m9.figshare.24946323
Additional file 2 of Chronic temporomandibular disorder pain patients with a history of neuropathic pain treatment: a narrative research on their diagnosis and treatment history
Baggen, J. H. M., Koevoets, A. C., Koutris, M., Steegers, M. A. H., & Lobbezoo, F. (2024) · Figshare · doi:10.6084/m9.figshare.24946738
Prognostic factors for pain intensity and function in individuals with temporomandibular disorders (TMDs): a systematic review and meta-analysis
Amaral, M. D. F. R. D. S., Fukusawa, L., Lourenço, B. M., Campos, M. G. M., Hage, Y. E., Oliveira, V. C., & de Freitas, D. G. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-103638
Everyday social contexts influence fluctuations into and out of chronic pain: an ethnographic study in England
Stone, S., Zeyen, A., & Gooberman-Hill, R. J. S. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-111270

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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Health Sciences › Medicine › Orthopedics and Sports 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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A prognostic approach to defining chronic pain

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