title: Psychiatric disorders and risk of transition to chronicity in men with first onset low back pain.
abstract: OBJECTIVE
  To assess whether pre-existing psychiatric diagnoses increase the likelihood of transitioning from sub-acute to chronic back pain.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Men (N = 140) experiencing a first onset of low back pain (LBP) were examined for lifetime psychiatric disorders approximately 8 weeks post pain-onset using the Diagnostic Interview Schedule (DIS-III-R), then re-evaluated at 6 months after pain onset to determine who did or did not progress to pain chronicity.
  
  
  METHODS
  Transition to chronic pain and disability was based on 6-month self-report measures of pain intensity and perceived disability.
  
  
  RESULTS
  Men with a pre-pain lifetime diagnosis of major depressive disorder had 5 times greater risk of transitioning to chronic LBP (odds ratio [OR] = 4.99; 95% confidence interval [CI] 1.49-16.76). Increased risk was also associated with a pre-pain lifetime diagnosis of generalized anxiety (OR = 2.45; 95% CI 1.06-5.68), post-traumatic stress (OR = 3.23; 95% CI 1.11-9.44), and with current nicotine dependence (OR = 2.49; 95% CI 1.15-5.40). There were no statistically significant effects for abuse or dependence of alcohol or other psychoactive substances.
  
  
  CONCLUSIONS
  Lifetime history of major depression or a major anxiety disorder may represent potential psychosocial "yellow flags" for the transition to chronicity in men with first-onset LBP. Screening for lifetime depressive or anxiety disorders may identify individuals at higher risk, who may benefit from referral for more intensive rehabilitation.
authors.affiliation: Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Shaw
authors.forename: Adrienne J
authors.initials: AJ
authors.lastname: Means-Christensen
authors.forename: Mark A
authors.initials: MA
authors.lastname: Slater
authors.forename: John S
authors.initials: JS
authors.lastname: Webster
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Patterson
authors.forename: Igor
authors.initials: I
authors.lastname: Grant
authors.forename: Steven R
authors.initials: SR
authors.lastname: Garfin
authors.forename: Dennis R
authors.initials: DR
authors.lastname: Wahlgren
authors.forename: Shetal
authors.initials: S
authors.lastname: Patel
authors.forename: J Hampton
authors.initials: JH
authors.lastname: Atkinson
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease / Q000523:psychology*; D006801:Humans; D017116:Low Back Pain / Q000523:psychology*; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000175:diagnosis; D008875:Middle Aged; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D014029:Tobacco Use Disorder / Q000150:complications; D055815:Young Adult