The Need for Multidimensional Stratification of Chronic Low Back Pain (LBP)

Overview

Journal Spine (Phila Pa 1976)

Specialty Orthopedics

Date 2017 May 25

PMID 28538598

Citations 11

Authors

Yoga Raja Rampersaud

Andrew Bidos

Caroline Fanti

Anthony V Perruccio

Affiliations

Soon will be listed here.

Abstract

Study Design: A cross-sectional study of Canadian patients suffering from low back pain (LBP) seeking primary care.

Objective: The aim of this study was to determine which existing primary care LBP stratification schema is associated with distinct subpopulations as characterized by easily identifiable primary epidemiological factors.

Summary Of Background Data: LBP is among the most frequent reasons for visits to primary care physicians and a leading cause of years lived with disability. In an effort to improve treatment response/outcomes in LBP primary care, different classification systems have been proposed in an effort to provide more tailored treatment with the intent of improving outcomes. Group-specific risk factors and underlying etiology might suggest a need for, or inform, changes to treatment approaches to optimize LBP outcomes.

Methods: Stratification by dominant mechanical pain patterns; chronicity risk; disability severity. Multinomial logistic regression was used to identify the system showing greatest variability in associations with age, sex, obesity, and comorbidity. Once identified, the remaining schemas were incorporated into the model.

Results: N = 970; mean age: 50 years (range: 18-93); 56% female. Stratification by pain pattern revealed greater variability. Adjusted analysis: Increasing age was associated with greater odds of intermittent, extension-based back- or leg-dominant pain [odds ratio (OR): 1.02 and 1.06; P < 0.01]; being male with leg-dominant pain (ORs > 2; P < 0.01). Overweight/obesity was associated with extension-based leg-dominant pain (OR = 2.6; P < 0.02) and increasing comorbidity with extension-based back-dominant pain (OR = 1.3; P < 0.01). Severe disability was associated only with constant leg pain (OR = 3.9; P < 0.01), and high chronicity risk with extension-based leg-dominant pain (OR = 0.4; P = 0.03).

Conclusion: Dominant mechanical symptom stratification resulted in further discrimination of an epidemiologically distinct and a large subgroup of LBP patients not identified by disability or chronicity risk stratification alone. Findings suggest a need for primary care initiated multidimensional stratification in chronic LBP.

Level Of Evidence: 3.

Citing Articles

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A Model to Implement Standardized Virtual Care for Low Back Pain Amongst a Large Network of Providers in Urban and Rural Settings.

Correale M, Soever L, Rampersaud Y J Prim Care Community Health. 2022; 13:21501319221130603.

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Predictors of response following standardized education and self-management recommendations for low back pain stratified by dominant pain location.

Perruccio A, Wong J, Badley E, Power J, Yip C, Rampersaud Y N Am Spine Soc J. 2022; 8:100092.

PMID: 35141656 PMC: 8820018. DOI: 10.1016/j.xnsj.2021.100092.

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Pak S, Miller M, Cheuy V J Patient Rep Outcomes. 2021; 5(1):81.

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Identification of subgroup effect with an individual participant data meta-analysis of randomised controlled trials of three different types of therapist-delivered care in low back pain.

Hee S, Mistry D, Friede T, Lamb S, Stallard N, Underwood M BMC Musculoskelet Disord. 2021; 22(1):191.

PMID: 33593341 PMC: 7885433. DOI: 10.1186/s12891-021-04028-8.

References

Hall H, McIntosh G, Boyle C . Effectiveness of a low back pain classification system. Spine J. 2009; 9(8):648-57. DOI: 10.1016/j.spinee.2009.04.017. View

Suri P, Rainville J, Kalichman L, Katz J . Does this older adult with lower extremity pain have the clinical syndrome of lumbar spinal stenosis?. JAMA. 2010; 304(23):2628-36. PMC: 3260477. DOI: 10.1001/jama.2010.1833. View

Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F . A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012; 64(6):2028-37. DOI: 10.1002/art.34347. View

Donelson R, McIntosh G, Hall H . Is it time to rethink the typical course of low back pain?. PM R. 2012; 4(6):394-401. DOI: 10.1016/j.pmrj.2011.10.015. View

Fairbank J, Gwilym S, France J, Daffner S, Dettori J, Hermsmeyer J . The role of classification of chronic low back pain. Spine (Phila Pa 1976). 2011; 36(21 Suppl):S19-42. DOI: 10.1097/BRS.0b013e31822ef72c. View

Hoy D, Smith E, Cross M, Sanchez-Riera L, Buchbinder R, Blyth F . The global burden of musculoskeletal conditions for 2010: an overview of methods. Ann Rheum Dis. 2014; 73(6):982-9. DOI: 10.1136/annrheumdis-2013-204344. View

Dagenais S, Caro J, Haldeman S . A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008; 8(1):8-20. DOI: 10.1016/j.spinee.2007.10.005. View

Leclaire R, Blier F, Fortin L, Proulx R . A cross-sectional study comparing the Oswestry and Roland-Morris Functional Disability scales in two populations of patients with low back pain of different levels of severity. Spine (Phila Pa 1976). 1997; 22(1):68-71. DOI: 10.1097/00007632-199701010-00011. View

E Murphy S, Blake C, Power C, Fullen B . The effectiveness of a stratified group intervention using the STarTBack screening tool in patients with LBP--a non randomised controlled trial. BMC Musculoskelet Disord. 2013; 14:342. PMC: 4029484. DOI: 10.1186/1471-2474-14-342. View

10.

Vos T, Flaxman A, Naghavi M, Lozano R, Michaud C, Ezzati M . Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380(9859):2163-96. PMC: 6350784. DOI: 10.1016/S0140-6736(12)61729-2. View

11.

Fairbank J, Pynsent P . The Oswestry Disability Index. Spine (Phila Pa 1976). 2000; 25(22):2940-52; discussion 2952. DOI: 10.1097/00007632-200011150-00017. View

12.

Genevay S, Atlas S . Lumbar spinal stenosis. Best Pract Res Clin Rheumatol. 2010; 24(2):253-65. PMC: 2841052. DOI: 10.1016/j.berh.2009.11.001. View

13.

Gellhorn A, Katz J, Suri P . Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol. 2012; 9(4):216-24. PMC: 4012322. DOI: 10.1038/nrrheum.2012.199. View

14.

Koes B, van Tulder M, Lin C, Macedo L, McAuley J, Maher C . An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010; 19(12):2075-94. PMC: 2997201. DOI: 10.1007/s00586-010-1502-y. View

15.

Keller A, Hayden J, Bombardier C, van Tulder M . Effect sizes of non-surgical treatments of non-specific low-back pain. Eur Spine J. 2007; 16(11):1776-88. PMC: 2223333. DOI: 10.1007/s00586-007-0379-x. View

16.

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 J. 2014; 14(8):1375-91. DOI: 10.1016/j.spinee.2014.05.002. View

17.

Ammendolia C, Stuber K, Rok E, Rampersaud R, Kennedy C, Pennick V . Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication. Cochrane Database Syst Rev. 2013; (8):CD010712. PMC: 11787928. DOI: 10.1002/14651858.CD010712. View

18.

Luo X, Pietrobon R, Sun S, Liu G, Hey L . Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine (Phila Pa 1976). 2003; 29(1):79-86. DOI: 10.1097/01.BRS.0000105527.13866.0F. View

19.

Gronblad M, Hupli M, Wennerstrand P, Jarvinen E, Lukinmaa A, Kouri J . Intercorrelation and test-retest reliability of the Pain Disability Index (PDI) and the Oswestry Disability Questionnaire (ODQ) and their correlation with pain intensity in low back pain patients. Clin J Pain. 1993; 9(3):189-95. DOI: 10.1097/00002508-199309000-00006. View

20.

Goode A, Carey T, Jordan J . Low back pain and lumbar spine osteoarthritis: how are they related?. Curr Rheumatol Rep. 2013; 15(2):305. PMC: 3606549. DOI: 10.1007/s11926-012-0305-z. View