THE EFFECT OF CHRONIFICATION ON THE QUALITY OF LIFE OF PATIENTS
WITH BACK PAIN
Title.
The transition from acute to subacute and
chronic low back pain: a study based on the determinants of
the quality of life and the risk of chronification.
Background.
It is known that acute low back pain and
chronic low back pain (that is, pain that lasts more than
90 days) are conceptually different. Contrary to what has
been long believed, chronic low back pain does not merely
mean the perpetuation of acute low back pain in time, acute
and chronic low back pain have different risk factors and
respond to different treatments, so that the procedures shown
to be effective for each kind of low back pain are different.
In general, the prognosis for chronic low back pain is worse
than that for acute. For this reason, it is important to take
the necessary measures as soon as possible to prevent the
chronification of acute low back pain. Thus, a duration of
pain (corresponding to "subacute low back pain")
has been defined to try to establish the moment when the appropriate
measures should be applied and which because of their cost
cannot be applied to all patients with acute low back pain.
However, the definition of that period is currently inconsistent
and is not based on any scientific study.
On the other hand, an earlier study has shown that the quality
of life in patients with low back pain is influenced by the
pain's intensity and by the degree of disability (that is,
the degree of limitation in daily activities). The influence
of these two factors increases over time and practically doubles
in two weeks. The first day when the patient sees the doctor
for pain, both factors together explain only 27% of the overall
quality of life, while 14 days later they explain 58%.
Finally, it is known that the influence of pain and disability
on the quality of life doubles in the first 14 days, but it
is not known what happens beyond this period. Nor is it known
whether this influence is similar in chronic patients. Knowing
this would allow for an optimization of treatment strategies,
focusing them to improve the quality of life (or to prevent
it from getting worse) of patients early and probably more
efficiently.
Objective.
To determine the transition calendar from
acute low back pain to subacute and chronic, basing it one
the evaluation of the determining factors for quality of life
and the risk of chronification.
Design.
Prospective, cohort study.
Methodology.
The study was made with a convenience sample
of 366 patients who visited their primary care physician for
acute or subacute low back pain (that is to say, that lasted
under 90 days).
The patients were evaluated on three occasions: the first
day they saw the doctor, and 15 and 60 days later. Thus, in
the last control the patients who were still subacute were
evaluated (that is, those in whom the sum of the period in
which they had suffered low back pain before seeing the doctor,
plus the two months follow-up, did not reach 90 days) and
patients who exceeded that limit.
On each occasion when their situation was evaluated, the
patients filled out two scales measuring the pain intensity
(one for low back pain and the other for referred or radiated
pain), a Roland Morris scale to determine the degree of their
disability and a EuroQol questionnaire to evaluate their quality
of life.
In the analysis phase, the correlation of the pain, disability
and quality of life was evaluated. Additionally, the situation
of the patients who became chronic was studied specially (that
is to say, those in whom the pain exceeded 90 days duration)
and the situation of those in whom disability and quality
of life did not improve over the follow-up period, in order
to determine the cut-off point for pain duration at which
the risk of chronification is greater.
Participants, along with the Foundation's
Science Department.
106 researchers from 40 Primary Care centers
and Primary Care Research Units in Badajoz, Baleares, Bilbao,
Burgos, Cáceres, Cuenca, Guadalajara, Huesca, Madrid,
Murcia, Palencia, Valencia, as well as the Unit of Clinical
Biostatistics at the Hospital Ramón y Cajal, Madrid;
all of them part of the Spanish Network of Researchers in
Back Disorders.
The study was funded by the Kovacs Foundation.
Status.
Data collection has
concluded and data is currently being analyzed.
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