Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2009 Oct 6:339:b3829.
doi: 10.1136/bmj.b3829.

Prognosis for patients with chronic low back pain: inception cohort study

Luciola da C Menezes Costa  1 , Christopher G Maher, James H McAuley, Mark J Hancock, Robert D Herbert, Kathryn M Refshauge, Nicholas Henschke
Affiliations
Multicenter Study

Prognosis for patients with chronic low back pain: inception cohort study

Luciola da C Menezes Costa et al. BMJ. .

Abstract

Objectives: To describe the course of chronic low back pain in an inception cohort and to identify prognostic markers at the onset of chronicity.

Design: Inception cohort study with one year follow-up.

Setting: Primary care clinics in Sydney, Australia.

Participants: The study sample was a subcohort of an inception cohort of 973 consecutive patients presenting to primary care with acute low back pain (<2 weeks' duration). 406 participants whose pain persisted for three months formed the inception cohort of patients with chronic low back pain.

Main outcome measures: Outcomes and putative predictors measured at initial presentation, onset of chronicity (study entry), and follow-up at nine and 12 months. Recovery was determined from measures of pain intensity, disability, and work status. The association between potential prognostic factors and time to recovery was modelled with Cox regression.

Results: Completeness of follow-up was 97% of total person time for all outcomes. The cumulative probability of being pain-free was 35% at nine months and 42% at 12 months and for complete recovery was 35% at nine months and 41% at 12 months. Of the 259 participants who had not recovered from pain related disability at entry to the chronic study, 47% had recovered by 12 months. Previous sick leave due to low back pain, high disability levels or high pain intensity at onset of chronicity, low levels of education, greater perceived risk of persistent pain, and being born outside Australia were associated with delayed recovery.

Conclusion: More than one third of patients with recent onset, non-radicular chronic low back pain recover within 12 months. The prognosis is less favourable for those who have taken previous sick leave for low back pain, have high disability levels or high pain intensity at onset of chronic low back pain, have lower education, perceive themselves as having a high risk of persistent pain, and were born outside Australia.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

None
Fig 1 Flow of participants through study
None
Fig 2 Kaplan-Meier survival curves (95% confidence intervals) of recovery from pain (n=406) and disability (n=259) and complete recovery (n=406)
See this image and copyright information in PMC

Comment in

References

    1. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006;15:S192-300. - PMC - PubMed
    1. Mounce K. Back pain. Rheumatology 2002;41:1-5. - PubMed
    1. Walker BF. The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J Spinal Disord 2000;13:205-17. - PubMed
    1. Koes BW, van Tulder MW, Ostelo R, Kim Burton A, Waddell G. Clinical guidelines for the management of low back pain in primary care: an international comparison. Spine 2001;26:2504-13. - PubMed
    1. Van Tulder MW, Koes BW, Metsemakers JF, Bouter LM. Chronic low back pain in primary care: a prospective study on the management and course. Fam Pract 1998;15:126-32. - PubMed

Publication types