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Predictors of Acute Neck and Back Pain Progression to Chronicity and Disability

Most episodes of back pain resolve within six weeks although many have symptoms which persist and debilitate them for years. The definition of acute pain used was pain lasting less than six weeks. Chronic pain was defined as pain persisting for three months or longer. Psychological factors are known to play a role in chronic pain. Other studies have shown that acute pain intensity, depressive symptoms, exposure to severe stressors and traumas, and negative pain beliefs can cause perpetuation of pain.

The authors studied the cognitive, affective and trauma factors in 84 acute back pain patients to see if any of the measures were predictive of progression to chronic pain and disability. The subjects were followed for three months. Subjects were excluded from the study if they had any history of spine surgery, previous neck or back pain within the six months prior to their current pain episode, history of any psychotic or delusional disorder, or if they had any serious co-occuring pain-related medical conditions. The mean duration of pain at the time of the initial visit was 3.6 weeks.

A battery of questionnaires was completed at enrollment and three months later. Pain intensity, pain disability, cumulative trauma exposure, depression, and pain schemas were assessed.

The authors found that greater exposure to past traumatic life events and depressed mood were most predictive of chronic pain. Depressed mood and negative pain beliefs were most predictive of chronic disability. Early detection of depressive symptoms and significant trauma exposure may identify those patients with acute neck or back pain who may be at greater risk for progressing to chronic pain and disability.

References: C. Young Casey, et al. Transition from acute to chronic pain and disability: A model including cognitive, affective, and trauma factors, PAIN January 2008. Volume 134. Issue 1-2. Pp. 69-79.

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