I’ve had low back pain now for 12 weeks. Some days are better than others. My primary care physician says my prognosis is “guarded”. What does that mean?

Of course, you really need to ask your physician what he or she has in mind when saying that your prognosis is guarded. Usually the term “guarded” means there are possible reasons why you might not get better. Since that is the case, no immediate promises can be made about your recovery.

But you have probably read reports where a patient’s prognosis was “upgraded” from critical to guarded, or guarded to stable. These are words that represent different shades of the same color or to put it another way, different places on the continuum from no recovery to full recovery.

Researchers who study back pain have identified various factors that predict a poor prognosis. In a recent study from The Netherlands, they combined the data from three different high-quality studies to identify three factors that predict which patients with low back pain (LBP) will go on to develop chronic LBP.

Their predictive model had three factors: 1) no change in pain intensity and disability during the first three months of low back pain, 2) high pain intensity at baseline, and 3) the presence of kinesiophobia (fear of movement) right from the start.

Other studies have found that age (older), gender (females), poor pain coping, the presence of back and leg pain, disability status, or fear avoidance behaviors can also predict less than optimal results from treatment (and thus a poorer prognosis).

You may have some combination of these variables leading your physician to think there are reasons why your recovery may be slowed. Check it out — it’s possible what your physician meant and how you perceived what was said are two different things.