Nearly 20% of patients with back pain report persistent symptoms, greater health care use
Nearly one in five of patients with back pain report a persistent trajectory with associated increased disability, pain and use of health care, according to data published in Arthritis Care & Research.
“The findings from this study extend previous work in clinical samples by comprehensively examining the trajectories of back pain in the general population with a wide age range — 15-plus years — and followed for a long period of time,” Mayilee Canizares, PhD, and Y. Raja Rampersaud, MD, PhD, both of the Krembil Research Institute, University Health Network in Toronto, told Healio Rheumatology. “We also extend previous studies as we compared a variety of health outcomes by the back-pain trajectory groups after controlling for socio-demographic, behavior-related factors and comorbidities.”
To analyze and characterize back-pain trajectories, and to compare indicators of health status, medication and health care use, the researchers studied data from the longitudinal part of the National Population Health Survey, a representative sample of the population of Canada from 1994 to 2011. The survey collected data every 2 years, providing nine cycles of data. For their study, Canizares and colleagues included 12,782 participants who were 15 years or older in 1994 and had at least three cycles of data available at baseline.
As part of the biannual survey, participants provided data on socio-demographics and education, behavior and physical activity, depression, comorbidities, pain, disability, and medication and health care use. The researchers used group-based trajectory analysis to organize participants based on the patterns presented during the course of their back pain throughout a follow-up period of 16 years. The researchers also analyzed indicators of pain, disability, and medication and health care use in each trajectory group.
According to the researchers, 45.6% of participants reported back pain at least once during the follow-up period. Among those participants, the researchers identified four trajectories, with 18% in the “persistent” group, 28.1% in the “developing” trajectory, 20.5% designated as “recovery” and 33.4% in the “occasional” group. According to the researchers, persistent and developing groups were characterized by demonstrating more pain preventing activities, disability, depression and comorbidities. The researchers also noted significant differences in medication and health care use patterns across the groups. There was a general trend of most to least health care and medication use in the persistent, developing, recovery and occasional groups, the researchers found. Participants in the recovery group had an increasing trajectory of opioid and antidepressants use.
“This study highlights the need to modify the ingrained general messaging that back pain goes away, for most people to include the reasonable probability of persistence over time,” Canizares and Rampersaud said. “As per recent guidelines, opioid use for low back pain should be avoided and, if deemed necessary for severe pain, should only be used for a short period of time to enable optimal nonpharmacological management. Long-term opioid use has not been shown to be beneficial for the management of back pain.” – by Jason Laday
Disclosure: Rampersaud reports personal consulting fees from Medtronic. Please see the study for all other additional relevant financial disclosures.