Can a Back Pain Screening Tool Help Classify Patients with Acute Pain into Risk Levels for Chronic Pain?

Overview

Journal Eur J Pain

Publisher Wiley

Specialties Critical Care
Neurology
Psychiatry

Date 2014 Nov 11

PMID 25381748

Citations 10

Authors

W E Mehling

A L Avins

M C Acree

T S Carey

F M Hecht

Affiliations

Soon will be listed here.

Abstract

Background: The 9-item STarT-Back screening tool was developed in primary care patients with low back pain (LBP) to identify those at greatest risk for chronic pain and requiring targeted treatment. We conducted a secondary data analysis study to examine the performance of comparable questionnaire items in a sample of primary care patients with well-defined acute LBP.

Methods: In a prospective cohort study, 605 primary care patients with LBP of less than 30 days answered a questionnaire with 6 items identical and 3 items analogous to the 9-item STarT-Back. Participants were followed up at 6 months and 2 years. STarT-Back rules were applied to classify participant's risk of chronic LBP, and the performance of the screening items in predicting outcomes was assessed using likelihood ratios.

Results: The proportion of patients with chronic pain at follow-up was considerably lower (6 months: 22%; 2 years: 25%) than in the STarT-Back validation cohort (40%) of patients with pain of any duration. The probability of developing chronic pain given a high-risk designation by items similar to the STarT-Back increased the pre-test probability to 31% and 35%. Likelihood ratios were close to 1.

Conclusions: A risk classification schema using the recommended cut-off scores with items similar to the STarT-Back in a primary care population with strictly defined acute LBP had limited ability to identify persons who progressed to chronic pain. The results suggest caution when applying the STarT-Back in patients with acute LBP and a need to consider a modification of its cut-offs.

Citing Articles

The clinical course of acute, subacute and persistent low back pain: a systematic review and meta-analysis.

Wallwork S, Braithwaite F, OKeeffe M, Travers M, Summers S, Lange B CMAJ. 2024; 196(2):E29-E46.

PMID: 38253366 PMC: 10805138. DOI: 10.1503/cmaj.230542.

Multidimensional risk factor analysis of acute low back pain progressing to chronicity: a longitudinal cohort study protocol.

Huang Y, Li C, Chen J, Jiang Y, Yang Y, Yang J Front Med (Lausanne). 2023; 10:1194521.

PMID: 37435537 PMC: 10330724. DOI: 10.3389/fmed.2023.1194521.

Development and internal validation of a machine learning prediction model for low back pain non-recovery in patients with an acute episode consulting a physiotherapist in primary care.

Knoop J, van Lankveld W, Beijer L, Geerdink F, Heymans M, Hoogeboom T BMC Musculoskelet Disord. 2022; 23(1):834.

PMID: 36057717 PMC: 9440317. DOI: 10.1186/s12891-022-05718-7.

Healthcare utilization and related costs among older people seeking primary care due to back pain: findings from the BACE-N cohort study.

Killingmo R, Storheim K, Van der Windt D, Zolic-Karlsson Z, Vigdal O, Kretz L BMJ Open. 2022; 12(6):e057778.

PMID: 35725262 PMC: 9214384. DOI: 10.1136/bmjopen-2021-057778.

Artificial intelligence to improve back pain outcomes and lessons learnt from clinical classification approaches: three systematic reviews.

Tagliaferri S, Angelova M, Zhao X, Owen P, Miller C, Wilkin T NPJ Digit Med. 2020; 3:93.

PMID: 32665978 PMC: 7347608. DOI: 10.1038/s41746-020-0303-x.

References

Deyo R, Dworkin S, Amtmann D, Andersson G, Borenstein D, Carragee E . Report of the NIH task force on research standards for chronic low back pain. Spine (Phila Pa 1976). 2014; 39(14):1128-43. DOI: 10.1097/BRS.0000000000000434. View

Hill J, Vohora K, Dunn K, Main C, Hay E . Comparing the STarT back screening tool's subgroup allocation of individual patients with that of independent clinical experts. Clin J Pain. 2010; 26(9):783-7. DOI: 10.1097/AJP.0b013e3181f18aac. View

Grotle M, Foster N, Dunn K, Croft P . Are prognostic indicators for poor outcome different for acute and chronic low back pain consulters in primary care?. Pain. 2010; 151(3):790-797. PMC: 3398128. DOI: 10.1016/j.pain.2010.09.014. View

Hill J, Whitehurst D, Lewis M, Bryan S, Dunn K, Foster N . Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet. 2011; 378(9802):1560-71. PMC: 3208163. DOI: 10.1016/S0140-6736(11)60937-9. View

Mehling W, Gopisetty V, Acree M, Pressman A, Carey T, Goldberg H . Acute low back pain and primary care: how to define recovery and chronification?. Spine (Phila Pa 1976). 2011; 36(26):2316-23. PMC: 3100452. DOI: 10.1097/BRS.0b013e31820c01a6. View

Mehling W, Gopisetty V, Bartmess E, Acree M, Pressman A, Goldberg H . The prognosis of acute low back pain in primary care in the United States: a 2-year prospective cohort study. Spine (Phila Pa 1976). 2012; 37(8):678-84. PMC: 3335773. DOI: 10.1097/BRS.0b013e318230ab20. View

Kovacs F, Seco J, Royuela A, Corcoll Reixach J, Abraira V . Predicting the evolution of low back pain patients in routine clinical practice: results from a registry within the Spanish National Health Service. Spine J. 2012; 12(11):1008-20. DOI: 10.1016/j.spinee.2012.10.007. View

Itz C, Geurts J, van Kleef M, Nelemans P . Clinical course of non-specific low back pain: a systematic review of prospective cohort studies set in primary care. Eur J Pain. 2012; 17(1):5-15. DOI: 10.1002/j.1532-2149.2012.00170.x. View

Turner J, Shortreed S, Saunders K, LeResche L, Berlin J, Von Korff M . Optimizing prediction of back pain outcomes. Pain. 2013; 154(8):1391-401. DOI: 10.1016/j.pain.2013.04.029. View

10.

Chou R . In the clinic. Low back pain. Ann Intern Med. 2014; 160(11):ITC6-1. DOI: 10.7326/0003-4819-160-11-201406030-01006. View

11.

Pengel L, Herbert R, Maher C, Refshauge K . Acute low back pain: systematic review of its prognosis. BMJ. 2003; 327(7410):323. PMC: 169642. DOI: 10.1136/bmj.327.7410.323. View

12.

Roland M, Morris R . A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine (Phila Pa 1976). 1983; 8(2):141-4. DOI: 10.1097/00007632-198303000-00004. View

13.

Von Korff M, Ormel J, Keefe F, Dworkin S . Grading the severity of chronic pain. Pain. 1992; 50(2):133-149. DOI: 10.1016/0304-3959(92)90154-4. View

14.

Klenerman L, Slade P, Stanley I, Pennie B, Reilly J, Atchison L . The prediction of chronicity in patients with an acute attack of low back pain in a general practice setting. Spine (Phila Pa 1976). 1995; 20(4):478-84. DOI: 10.1097/00007632-199502001-00012. View

15.

Dionne C, Koepsell T, von Korff M, Deyo R, Barlow W, Checkoway H . Formal education and back-related disability. In search of an explanation. Spine (Phila Pa 1976). 1995; 20(24):2721-30. DOI: 10.1097/00007632-199512150-00014. View

16.

Beurskens A, de Vet H, Koke A . Responsiveness of functional status in low back pain: a comparison of different instruments. Pain. 1996; 65(1):71-76. DOI: 10.1016/0304-3959(95)00149-2. View

17.

van Tulder M, Koes B, Bouter L . Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions. Spine (Phila Pa 1976). 1997; 22(18):2128-56. DOI: 10.1097/00007632-199709150-00012. View

18.

Linton S, Hallden K . Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain. Clin J Pain. 1998; 14(3):209-15. DOI: 10.1097/00002508-199809000-00007. View

19.

Kovacs F, Abraira V, Zamora J, Fernandez C . The transition from acute to subacute and chronic low back pain: a study based on determinants of quality of life and prediction of chronic disability. Spine (Phila Pa 1976). 2005; 30(15):1786-92. DOI: 10.1097/01.brs.0000172159.47152.dc. View

20.

Grotle M, Vollestad N, Brox J . Clinical course and impact of fear-avoidance beliefs in low back pain: prospective cohort study of acute and chronic low back pain: II. Spine (Phila Pa 1976). 2006; 31(9):1038-46. DOI: 10.1097/01.brs.0000214878.01709.0e. View