The symptom of night pain in a back pain triage clinic

Abstract

Study design: Prospective longitudinal study of patients attending a back pain triage clinic with night pain.

Objective: To assess the importance of the symptom of night pain in patients attending a back pain triage clinic.

Summary of background data: The 1994 US Agency for Health Care Policy and Research guidelines suggest nighttime pain should be used as a "red flag." Night pain is known to occur in many conditions, and although common in patients with known serious pathology, the prevalence of night pain in a back pain triage clinic is not known.

Methods: A total of 482 consecutive patients attending a back pain triage clinic were assessed, including history of frequency and duration of night pain. Clinical examination was performed, and demographic data obtained. Magnetic resonance imaging was performed if indicated according to local guidelines. Oswestry, visual analog scales (for pain), and hospital anxiety depression scale, patient-based outcome scores were obtained.

Results: There were 213 patients who had night pain, with 90 having pain every night. No serious pathology was identified. Patients with night pain had 4.95 hours continuous sleep (range 2-7) and were woken 2.5 times/night (range 0-6). Patients with pain every night had higher Oswestry, visual analog scale, and hospital anxiety depression scale scores than those who did not.

Conclusions: Although it is a significant and disruptive symptom for patients, these results challenge the specificity of the presence of night pain per se as a useful diagnostic indicator for serious spinal pathology in a back pain triage clinic.