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. 2022 Nov 1;163(11):e1104-e1114.
doi: 10.1097/j.pain.0000000000002661. Epub 2022 Apr 25.

Temporal stability of self-reported visual back pain trajectories

Casper Glissmann Nim  1   2 , Alice Kongsted  3   4 , Aron Downie  5 , Werner Vach  4   6
Affiliations

Temporal stability of self-reported visual back pain trajectories

Casper Glissmann Nim et al. Pain. .

Abstract

Low back pain (LBP) follows different pain trajectories, and patients seem to recognize their trajectory. This allows self-reported visual pain trajectories (SRVTs) to support patient-provider communication. Pain trajectories appear stable over time for many patients, but the evidence is sparse. Our objectives were to investigate the (1) temporal stability of SRVTs over 1 year concerning pain intensity and course patterns and (2) association of transitions between SRVTs and changes in pain and disability. This study used data from 2 prospective primary care cohorts: the Danish Chiropractic LBP Cohort (n = 1323) and the GLA:D Back cohort (n = 1135). Participants identified one of the 8 SRVTs at baseline and 12-month follow-up, each asking about LBP trajectories the preceding year. Trajectories were described using 2 subscales (intensity and pattern). Temporal stability was quantified by "stability odds ratios" (ORs), depicting the likelihood of staying in the same SRVT after 12 months compared with baseline, and by "preference ORs," depicting the likelihood of choosing a specific alternative SRVT at follow-up. Both ORs compare the observed proportion with the chance level. Finally, we examined associations between transitioning to a different trajectory and changes in clinical outcomes. Approximately 30% stayed in the same SRVT. The stability ORs were all >1. The preference ORs indicated that transitions occurred mainly to similar SRVTs differing in only 1 subscale. Transitions to less or more intense SRVTs were associated with changes in clinical outcomes in the expected direction. Despite distinctly different SRVTs identified, individuals reported relatively stable LBP phenotypes but with potential for change.

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Conflict of interest statement

A. Kongsted's position at the University of Southern Denmark is financially supported by the Danish Chiropractic Fund for Research and Postgraduate Research. The remaining authors declare no conflicts of interest.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1.
Figure 1.
Study flow of participants consenting to participate in 2 primary care cohorts.
Figure 2.
Figure 2.
Distribution of self-reported visual pain trajectories at baseline and after 12-month follow-up in 2 primary care cohorts. SRVT, self-reported visual pain trajectory.
Figure 3.
Figure 3.
Sankey diagrams showing the proportions of participants in each self-reported visual pain trajectory at baseline and follow-up for the ChiCo and GLA:D Back cohorts. The height of the bars and lines represents the number of participants.
Figure 4.
Figure 4.
Stability odds ratios of the 8 self-reported visual pain trajectories and the classes defined by the intensity and pattern subscales. The y-axis is illustrated on a logarithmic scale, and the numbers indicate the number of participants staying. SRVT, self-reported visual pain trajectory.
Figure 5.
Figure 5.
Preference odds ratios of transitioning from 1 self-reported visual pain trajectory at baseline to another at follow-up. The figure shows preference odds ratios for each possible transition with the number of participants who transition in brackets. SRVT, self-reported visual pain trajectory.
Figure 6.
Figure 6.
Clinical changes across transitioning to different self-reported visual pain trajectory patterns. Results are illustrated as mean values. A higher negative score indicates more improvement. Numbers next to the bar indicate the number of participants. SRVT, self-reported visual pain trajectory.
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