Predicting chronic back pain

Researchers from Neuroscience Research Australia (NeuRA) have developed a model to predict whether a person with acute back pain is likely to go on to develop chronic back pain (lasting longer than three months). Their tool, called PICKUP, is said to have better predictive accuracy for pain outcomes than either clinician judgement or commonly used screening tools.

Writing in the journal PLOS Medicine, the researchers note that low back pain (LBP) is a major health problem — one that is responsible for the most years lived with disability. Chronic LBP is especially problematic, with a poor prognosis and interventions that are only moderately effective.

Early, accurate prognostic information provides the opportunity for practitioners to advise their patients on whether or not further treatments will be necessary. However, offering tests and treatments to all patients is expensive. Early intervention for those most at risk of transitioning to chronic pain before they do so is therefore the ideal scenario.

With this in mind, the research team developed a five-item screening questionnaire study using data from 1230 patients with a recent episode of LBP. They then tested how well the screening questionnaire could predict the onset of persistent pain in a separate sample of 1528 patients.

The screening questionnaire was found to predict the onset of persistent pain with an impressive level of accuracy, with the researchers noting that “if decisions to recommend further intervention were based on risk scores, screening could lead to a net reduction of 40 unnecessary interventions for every 100 patients presenting to primary care”. It has since been made available for healthcare practitioners and researchers to make an early estimate of a patient’s risk of developing chronic LBP.