Predicting persistent disabling low back pain in general practice: a prospective cohort study.
BACKGROUND
Patients may adopt active and/or passive coping strategies in response to pain. However, it is not known whether these strategies may also precede the onset of chronic symptoms and, if so, whether they are independent predictors of prognosis.


OBJECTIVE
To examine, in patients with low back pain in general practice, the prognostic value of active and passive coping styles, in the context of baseline levels of pain, disability and pain duration.


METHODS
Prospective cohort study.


METHODS
Nine general practices in north west England.


METHODS
Patients consulting their GP with a new episode of low back pain were recruited to the study. Information on coping styles, pain severity, disability, duration, and a brief history of other chronic pain symptoms was recorded using a self-completion postal questionnaire. Participants were then sent a follow-up questionnaire, 3 months after their initial consultation, to assess the occurrence of low back pain. The primary outcome was persistent disabling low back pain, that is, low back pain at 3-month follow-up self-rated as >or=20 mm on a 100 mm visual analogue scale, and >or=5 on the Roland and Morris Disability Questionnaire.


RESULTS
A total of 974 patients took part in the baseline survey, of whom 922 (95%) completed a follow-up questionnaire; 363 individuals (39%) reported persistent disabling pain at follow-up. Persons who reported high levels of passive coping experienced a threefold increase in the risk of persistent disabling low back pain (relative risk [RR] = 3.0; 95% confidence interval [CI] = 2.3 to 4.0). In contrast, active coping was associated with neither an increase nor a decrease in the risk of a poor prognosis. After adjusting for baseline pain severity, disability, and other measures of pain and pain history, persons who reported a high passive coping score were still at 50% increased risk of a poor outcome (RR = 1.5; 95% CI = 1.1 to 2.0).


CONCLUSIONS
Patients who report passive coping strategies experience a significant increase in the risk of persistent symptoms. Further, this risk persists after controlling for initial pain severity and disability. The identification of this low back pain subgroup may help target future treatments to those at greatest risk of a poor outcome.
Jones
Gareth T
GT
Epidemiology Group, Department of Public Health, University of Aberdeen, Aberdeen. gareth.jones@abdn.ac.uk
Johnson
Ruth E
RE
Wiles
Nicola J
NJ
Chaddock
Carol
C
Potter
Richard G
RG
Roberts
Chris
C
Symmons
Deborah P M
DP
Macfarlane
Gary J
GJ
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires