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Can a back pain screening tool help classify patients with acute pain into risk levels for chronic pain?
Author(s) -
Mehling W.E.,
Avins A.L,
Acree M.C,
Carey T.S,
Hecht F.M.
Publication year - 2015
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1002/ejp.615
Subject(s) - medicine , chronic pain , physical therapy , cohort , primary care , low back pain , back pain , cohort study , population , acute pain , family medicine , alternative medicine , anesthesia , environmental health , pathology
Background The 9‐item STarT ‐ B ack screening tool was developed in primary care patients with low back pain ( LBP ) to identify those at greatest risk for chronic pain and requiring targeted treatment. We conducted a secondary data analysis study to examine the performance of comparable questionnaire items in a sample of primary care patients with well‐defined acute LBP . Methods In a prospective cohort study, 605 primary care patients with LBP of less than 30 days answered a questionnaire with 6 items identical and 3 items analogous to the 9‐item STarT ‐ B ack. Participants were followed up at 6 months and 2 years. STarT ‐ B ack rules were applied to classify participant's risk of chronic LBP , and the performance of the screening items in predicting outcomes was assessed using likelihood ratios. Results The proportion of patients with chronic pain at follow‐up was considerably lower (6 months: 22%; 2 years: 25%) than in the STarT ‐ B ack validation cohort (40%) of patients with pain of any duration. The probability of developing chronic pain given a high‐risk designation by items similar to the STarT ‐ B ack increased the pre‐test probability to 31% and 35%. Likelihood ratios were close to 1. Conclusions A risk classification schema using the recommended cut‐off scores with items similar to the STarT ‐ B ack in a primary care population with strictly defined acute LBP had limited ability to identify persons who progressed to chronic pain. The results suggest caution when applying the STarT ‐ B ack in patients with acute LBP and a need to consider a modification of its cut‐offs.