How to identify patients with a poor prognosis in daily clinical practice.
Predicting poor outcomes in daily practice is challenging. As well as prior episodes of low back pain and pain intensity, various psychosocial risk factors have been identified, although the independent prognostic value of these is rather low. This supports the necessity for a multidimensional view of the transition from acute to chronic pain and/or the development of disability. Psychological distress has been found to increase the risk of such a transition. Patients' beliefs and expectations about their pain seem to influence the recovery process; pain-related fear and fear avoidance can be influential psychological variables, from pain inception to its chronic stage. The influence of occupational factors such as job satisfaction, low workplace support or physical workload has also been emphasized. Treatment provider factors and the relationship between patients and care providers also contribute to the realistic or unrealistic expectations and meaningful or acceptable outcomes.
Cedraschi
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Multidisciplinary Pain Centre, Service of Clinical Pharmacology and Toxicology and Division of General Medical Rehabilitation, Geneva University Hospitals, 1211 Geneva 14, Switzerland. cristine.cedraschi@hcuge.ch
Allaz
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D002908:Chronic Disease; D004185:Disability Evaluation; D018450:Disease Progression; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology*; D010817:Physician-Patient Relations; D011237:Predictive Value of Tests; D011379:Prognosis; D012803:Sick Role; D017132:Workplace / Q000523:psychology*