Prevalence and characteristics of flare-ups of chronic nonspecific back pain in primary care: a telephone survey.
OBJECTIVE
To describe the prevalence and characteristics of flare-ups of chronic nonspecific back pain (CNSBP) among primary care patients, and to examine associations with measures of pain severity and psychosocial factors.


METHODS
Six hundred thirty-four participants with nonspecific back pain were interviewed by telephone 2 years after an initial primary care visit for back pain. Participants experiencing flare-ups in the last 6 months reported on frequency, duration, and other characteristics of flare-ups. Using bivariate and multivariate analyses, we compared individuals with and without CNSBP flare-ups with respect to demographic characteristics, measures of pain severity, and psychosocial factors.


RESULTS
Approximately 51% of the participants reported flare-ups. Physical activities, including lifting and bending, were the most common perceived triggers of flare-ups. Participants with flare-ups experienced greater levels of pain intensity, disability, opioid medication use, and psychosocial comorbidities. After adjustment for demographic factors, pain intensity, and pain frequency, participants with flare-ups were more disabled than those without [mean (95% confidence interval) disability score 4.2 (3.9-4.4) vs. 3.3 (2.9-3.6); P<0.0001] and demonstrated higher levels of passive coping [mean passive coping score 4.1(3.8-4.3) vs. 3.4 (3.1-3.7); P=0.0008].


CONCLUSIONS
Flare-ups of CNSBP are common among primary care patients, and are independently associated with higher levels of pain intensity, disability, and passive coping. The presence of flare-ups and the perception of activity as a trigger may predispose patients with flare-ups to experience disability not explained by pain intensity alone. Further longitudinal studies are required to better characterize CNSBP flare-ups and determine their clinical implications.
VA Boston Healthcare System, Boston, MA, USA. pradeep.suri@va.gov
Pradeep
P
Suri
Kathleen W
KW
Saunders
Michael
M
Von Korff
D000293:Adolescent; D000328:Adult; D000368:Aged; D001416:Back Pain / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D002908:Chronic Disease / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010147:Pain Measurement; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D057566:Self Report; D013689:Telephone; D055815:Young Adult