A new study on conversion of acute to chronic low back pain identifies clinician behavior as well as patient characteristics that increase that risk.
Acute low back pain (LBP) is one of the most common complaints for which people see their primary care physicians. While the pain will resolve for most patients, for an estimated one-third, the pain lasts ≥ 6 months and is then considered chronic. LBP is a major public health problem and is the leading cause of disability in the US.
A recent study published in JAMA Network Open, sought to identify risk factors that could be associated with the acute-to-chronic conversion and whether an instrument used to identify patients with LBP at risk of persistent functional limitations is useful for determining who is more likely to be develop chronic LBP.
Find the study, findings, and conclusions at-a-glance in these slides.
Stevens JM, Delitto A, Khoja SS, et al. Risk factors associated with transition from acute to chronic low back pain in US patients seeking primary care. JAMA Network Open. 2021;4:e2037371.
Study: 77 primary care practices in 4 geographic regions; a total of 5233 patients presenting with acute low back pain with documented 6-mo follow-up .
Pain impact at onset of care ups risk. 32% of patients with acute LBP still had pain 6 mos after initial visit. Pain and its interference on functioning, per SBST at onset of care, was correlated with the transition to chronic LBP.
Patient factors add complexity. Other factors found to be associated with an increased risk of developing chronic LBP included: LBP with leg pain, smoking, obesity, Medicaid as primary health insurance. diagnosis of depressive or anxiety disorders.
This provider factor can be modified. Nonconcordant care also was associated with increased odds of transition from acute to chronic LBP: Care provided to patients within 21 days of first visit and which was not consistent with published guidelines on the management of acute LBP.
Nonconcordant care. Nonconcordant care included opioid and benzodiazepine prescriptions, unwarranted orders for imaging, specialist referrals.
Nonconcordant care had an impact on conversion from acute to chronic LBP independent of patient characteristics. 48% of patients received at least 1 nonconcordant intervention within 3 weeks of initial visit. Medication prescribing was the most common type of nonconcordant care, with opioid prescribing being the most common of these.
Study conclusions. The SBST may be a useful instrument to help determine which patients with acute LBP are at greatest risk for transition to chronic LBP. Lifestyle changes, weight loss and smoking cessation in particular, may reduce the risk of developing chronic LBP. Of greatest importance in limiting transition to chronic LBP is physician's management of patients with acute LBP; study authors note the most important as: Following published guidelines on management of acute LBP, especially avoiding opioid prescribing and unnecessary referrals for radiologic studies