A prognostic approach to defining chronic pain: replication in a UK primary care low back pain population
Abstract
A novel prognostic approach to defining chronic pain was developed in a US primary care low back pain population, using a combination of information about pain history, current status and likely prognosis. We tested whether this method was generalizable to a UK population. A prospective cohort of 426 patients who consulted with back pain at one of five UK general practices, and who returned follow-up information 1-year later were included. A baseline risk score was calculated based on pain severity and prognostic measures (depression, diffuse pain, pain duration), and cut-points from the US study applied for the risk of future clinically significant back pain, as defined by Chronic Pain Grades 2-4. New cut-points were also derived for the UK population using identical methods. The cut-points for probable and possible chronic pain developed in the US population (80% and 50% probability of future clinically significant back pain, respectively) were appropriate for the UK population, but the cut-point for classifying people at low risk (20% probability) was not replicated in the UK sample. The newly derived cut-points in the UK sample were similar; they remained the same for probable chronic pain, were slightly increased for possible chronic pain, and slightly reduced for those at intermediate or low risk. This method for defining chronic pain prospectively, using risk thresholds for future clinically significant pain, appears to be generalizable to a UK back pain population, particularly for identifying probable chronic pain, and may be generalizable to other primary care low back pain populations.
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The items used for impact stratification (pain intensity, pain interference, and functional status) have substantial research support for their discriminatory and prognostic importance.
“These items have substantial research support to validate their discriminatory and prognostic importance. 13, 19, 31, 38, 39, 43, 47–49, 53, 54, 57–60, 66–68, 73, 76, 80, 82, 85, 86, 97, 106, 108, 110, 112–116, 122”
From Report of the NIH Task Force on research standards for chronic low back pain. (2014) · cites this paper as [38]
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 [5]
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- Authors
- Dunn, K. M., Croft, P. R., Main, C. J., & Von Korff, M.
- Affiliations
- Keele University (GB)
- Corresponding author
- Dunn, Kate M.
- Venue
- Pain
- Published
- 2008-03
- Volume
- 135
- Issue
- 1
- Pages
- 48-54
- ISSN
- 0304-3959 (ISSN-L)
- OpenAlex
- W2000462586
- Cited by
- 61
- References
- 23
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 1 · 2022: 2 · 2021: 3 · 2020: 2 · 2019: 2 · 2018: 4 · 2017: 2 · 2016: 3 · 2015: 4 · 2014: 13 · 2013: 7 · 2012: 1
- FWCI
- 1.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Wellcome Trust
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- chronic pain, low back pain, prognostic stratification, risk score, cut points, generalizability, primary care, pain intensity, depression, diffuse pain, pain duration
- MeSH terms
- Adult, Chronic Disease, Disability Evaluation, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pain, Pain Measurement, Predictive Value of Tests, Probability, Prognosis, Surveys and Questionnaires
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