Psychosocial Predictors of Outcome in Acute and Subchronic Low Back Trouble
Abstract
STUDY DESIGN: A prospective survey of patients seeking primary care for low back pain. Clinical and psychosocial data, available at presentation, were explored for predictors of outcome at 1 year. OBJECTIVES: To determine the relative value of clinical and psychosocial variables for early identification of patients with a poor prognosis. SUMMARY OF BACKGROUND DATA: Current treatment strategies for low back pain have failed to stem the rising levels of disability. Psychosocial factors have been shown to be important determinants of response to therapy in chronic patients, but the contribution from similar data in acute or subchronic patients has not been comprehensively investigated. METHODS: Two hundred fifty-two patients with low back pain, presenting to primary care, underwent a structured clinical interview and completed a battery of psychosocial instruments. Follow-up was done by mail at 1 year; outcome was measured using a back pain disability questionnaire. Predictive relationships were sought between the data at presentation and disability at follow-up. RESULTS: Most patients showed improved disability and pain scores, although more than half had persisting symptoms. Eighteen percent showed significant psychological distress at presentation. Multiple regression analysis showed the level of persisting disability to depend principally on measures in the psychosocial domain; for acute cases outcome is also dependent on the absence or presence of a previous history of low back trouble. Discriminant models successfully allocated typically 76% of cases to recovered/not-recovered groups, largely on the basis of psychosocial factors evident at presentation. CONCLUSIONS: Early identification of psychosocial problems is important in understanding, and hopefully preventing, the progression to chronicity in low back trouble.
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Pain catastrophising is associated with occupational disability.
“occupational disability [11-13]”
From Effectiveness of cognitive behaviour therapy for the treatment of catastrophisation in patients with fibromyalgia: A randomised controlled trial (2011) · cites this paper as [11]
Pain catastrophizing has been associated with occupational disability.
“Some of the consequences that have been associated with pain catastrophizing are more intense pain [6], heightened pain behaviour [7-9], greater analgesic consumption [10,11], reduced involvement in daily activities [3], occupational disability [12-14] and suicidal ideation [15].”
From Effectiveness of the psychological and pharmacological treatment of catastrophization in patients with fibromyalgia: a randomized controlled trial. (2009) · cites this paper as [12]
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“The present research is consistent with the findings of previous investigations showing that psychosocial factors are significant determinants of work disability (5,13,14,19).”
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Does anticipation of back pain predispose to back trouble?
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“Pain report usually increases with the progression from the acute to the chronic pain state (Sedlak, 1985; Burton et al., 1995; van der Kloot et al., 1996) and patients with persisting pain were shown to have suffered from more severe pain in the acute phase than patients whose pain resolved…”
InfluentialThe centralization phenomenon of spinal symptoms—a systematic review
Aina, A., May, S., & Clare, H. A. (2004) · Manual Therapy · doi:10.1016/j.math.2004.03.004 · Cited by 172 · see citing works
“…of psychosocial variables as prognostic factors (Chavannes et al., 1986; Lanier and Stockton, 1988; Goertz, 1990; Hasenbring et al., 1994; Burton et al., 1995; Gatchel et al., 1995; ARTICLE IN PRESS A. Aina et al. / Manual Therapy 9 (2004) 134–143140 Hazard et al., 1996; Smedley et al.,…”
BackgroundThe relation between catastrophizing and the communication of pain experience
Sullivan, M. J. L., Martel, M. O., Tripp, D. A., Savard, A., & Crombez, G. (2006) · Pain · doi:10.1016/j.pain.2006.02.001 · Cited by 175 · see citing works
“E-mail address: michael.jl.sullivan@umontreal.ca (M.J.L. Sullivan). et al., 1997), reduced involvement in daily activities (Keefe et al., 1989), and occupational disability (Burton et al., 1995; Sullivan et al., 1998; Sullivan and Stanish, 2003).”
BackgroundAre first-time episodes of serious LBP associated with new MRI findings?
Carragee, E. J., Alamin, T. F., Cheng, I., Franklin, T., van den Haak, E., & Hurwitz, E. L. (2006) · The Spine Journal · doi:10.1016/j.spinee.2006.03.005 · Cited by 169 · see citing works
Skargren, E. I., Carlsson, P. G., & Öberg, B. E. (1998) · Spine · doi:10.1097/00007632-199809010-00016 · Cited by 169 · see citing works
A Prospective Follow-Up Study of Low Back Pain in the Community
Waxman, R., Tennant, A. H., & Helliwell, P. (2000) · Spine · doi:10.1097/00007632-200008150-00013 · Cited by 166 · see citing works
“5,4) 181, 100 1997 110, 61 (54,68) 58, 32 (25,39) 12, 7 (3,10) 180, 100 Intermittent LBP 1994 316, 79 (75,79) 71, 18 (14,22) 12, 3 (1,5) 399, 100 1997 279, 70 (65,74) 105, 26 (22,31) 17, 4 (2,6) 400, 100 Total 1994 1115, 77 (75,79) 217, 15 (13,17) 123, 9 (7,9) 1455, 100 1997 932, 64 (62,67) 396, 27 (25,30) 125, 9 (7,1…”
Meints, S. M., Mawla, I., Napadow, V., Kong, J., Gerber, J. A., Chan, S., Wasan, A. D., Kaptchuk, T. J., McDonnell, C., Carrière, J. S., et al. (2018) · Pain · doi:10.1097/j.pain.0000000000001461 · Cited by 166 · see citing works
A prospective sequential analysis of the fear-avoidance model of pain
Wideman, T. H., Adams, H., & Sullivan, M. J. L. (2009) · Pain · doi:10.1016/j.pain.2009.04.022 · Cited by 162 · see citing works
Holroyd, K. A., Drew, J., Cottrell, C., Romanek, K., & Heh, V. (2007) · Cephalalgia · doi:10.1111/j.1468-2982.2007.01420.x · Cited by 163 · see citing works
A Systematic Review of the Predictive Ability of the Orebro Musculoskeletal Pain Questionnaire
Hockings, R. L., McAuley, J. H., & Maher, C. G. (2008) · Spine · doi:10.1097/brs.0b013e31817ba3bb · Cited by 161 · see citing works
Clinical Course and Impact of Fear-Avoidance Beliefs in Low Back Pain
Grotle, M., Vøllestad, N. K., & Brox, J. I. (2006) · Spine · doi:10.1097/01.brs.0000214878.01709.0e · Cited by 161 · see citing works
Long-term Outcomes of Lumbar Fusion Among Workers’ Compensation Subjects
Nguyen, T. H., Randolph, D. C., Talmage, J. B., Succop, P. S., & Travis, R. L. (2010) · Spine · doi:10.1097/brs.0b013e3181ccc220 · Cited by 157 · see citing works
Artus, M., van der Windt, D., Jordan, K. P., & Hay, E. M. (2010) · Rheumatology · doi:10.1093/rheumatology/keq245 · Cited by 156 · see citing works
Pain catastrophizing and general health status in a large Dutch community sample
Severeijns, R., van den Hout, M. A., Vlaeyen, J. W. S., & Picavet, S. J. H. (2002) · Pain · doi:10.1016/s0304-3959(02)00219-1 · Cited by 156 · see citing works
“Furthermore, the study design does not permit a judgement on the direction of this association although some prospective studies suggest that catastrophizing is a precursor of pain-related variables such as disability rather than a consequence (Burton et al., 1995; Linton et al., 2000).”
1999 Young Investigator Research Award Winner
McIntosh, G., Frank, J. W., Hogg‐Johnson, S., Bombardier, C., & Hall, H. (2000) · Spine · doi:10.1097/00007632-200001150-00003 · Cited by 153 · see citing works
George, S., Fritz, J., & McNeil, D. (2006) · The Clinical Journal of Pain · doi:10.1097/01.ajp.0000148627.92498.54 · Cited by 165 · see citing works
“This finding converges with previous longitudinal studies suggesting that elevated psychosocial factors relevant to chronic disability from low back pain are present during acute stages of injury.(5,6,35,36) This study expands on the previous studies by demonstrating the sensitivity of changes in fear-avoidance belief…”
ResultAnálise das propriedades psicométricas da versão brasileira da escala tampa de cinesiofobia
Siqueira, F. B., Teixeira‐Salmela, L. F., & Magalhães, L. D. C. (2007) · Acta Ortopédica Brasileira · doi:10.1590/s1413-78522007000100004 · Cited by 154 · see citing works
Frost, H., Lamb, S. E., Moffett, K. A. J., Fairbank, T. J. C., & Moser, S. J. (1998) · Pain · doi:10.1016/s0304-3959(98)00005-0 · Cited by 152 · see citing works
Behavioral Responses to Examination
Main, C. J., & Waddell, G. (1998) · Spine · doi:10.1097/00007632-199811010-00025 · Cited by 152 · see citing works
Self-citationEnthoven, P., Skargren, E. I., & Öberg, B. E. (2004) · Spine · doi:10.1097/01.brs.0000143025.84471.79 · Cited by 151 · see citing works
“1) 1–4 wk 81 20 22 (16;25) 23 26 (17;29) 2.”
BackgroundInfluentialKoleck, M., Mazaux, J., Rascle, N., & Bruchon‐Schweitzer, M. (2005) · European Journal of Pain · doi:10.1016/j.ejpain.2005.01.003 · Cited by 150 · see citing works
“In the context of prospective studies, catastrophizing and fear-avoidance beliefs were found to be the most powerful predictors of pain and disability (Burton et al., 1995; Hasenbring et al., 1994; Klenerman et al., 1995; Linton and Hallden, 1998; Picavet et al., 2002).”
BackgroundResultInfluential
- Authors
- Burton, A. K., Tillotson, K. M., Main, C. J., & Hollis, S.
- Affiliations
- University of Huddersfield (GB)
- Salford Royal NHS Foundation Trust (GB)
- Corresponding author
- Tillotson, K. Malcolm
- ORCID
- Main, Chris J.
- Venue
- Spine
- Published
- 1995-03
- Volume
- 20
- Issue
- 6
- Pages
- 722-728
- ISSN
- 0362-2436 (ISSN-L)
- OpenAlex
- W1970664734
- Cited by
- 700
- References
- 0
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 11 · 2023: 9 · 2022: 9 · 2021: 18 · 2020: 13 · 2019: 14 · 2018: 19 · 2017: 13 · 2016: 19 · 2015: 15 · 2014: 22 · 2013: 22 · 2012: 29
- FWCI
- 15.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Spine (publishedVersion)
- PubMed (publishedVersion)
- University of Huddersfield Repository (University of Huddersfield) (submittedVersion)
- Lancaster EPrints (Lancaster University) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Huddersfield Research Portal (University of Huddersfield) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Keywords
- low back pain, psychosocial factors, prognosis, disability, psychological distress, acute low back pain, outcome prediction, primary care
- MeSH terms
- Acute Disease, Adult, Chronic Disease, Disability Evaluation, Female, Follow-Up Studies, Humans, Male, Pain Measurement, Prospective Studies, Discriminant Analysis, Low Back Pain
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