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Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_2 | Pages 1 - 1
1 Feb 2018
Chen Y Campbell P Strauss V Foster N Jordan K Dunn K
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Background and objectives

Low back pain (LBP) is a major health challenge globally. Research has identified common trajectories of pain over time. We aimed to investigate whether trajectories described in one primary care cohort can be confirmed in another, and to determine the prognostic value of factors collected 5 years prior to the identification of the trajectory.

Methods and results

The study was carried out on 281 patients who had consulted primary care for LBP, at that point completed a baseline questionnaire, and then returned a questionnaire at 5-years follow-up plus at least 3 (of 6) subsequent monthly questionnaires. Baseline factors were measured using validated tools. Pain intensity scores from the 5-year follow-up and monthly questionnaires were used to cluster participants into 4 previously derived pain trajectories (no or occasional mild, persistent mild, fluctuating, persistent severe), using latent class analysis. Posterior probabilities of belonging to each cluster were estimated for each participant. The posterior probabilities for the assigned clusters were very high (>0.90) for each cluster except for the smallest ‘fluctuating’ cluster (0.74). Lower social class (OR 2.9; 95% CI 1.2, 7.0), higher pain intensity (1.6 per unit; 1.2, 2.2), and pain duration greater than 3 years (2.7; 1.0, 7.3), were significantly associated with a more severe trajectory 5-years later, as were higher physical disability, emotional impact of pain, and perception pain will last a long time.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_I | Pages 16 - 16
1 Jan 2012
Campbell P Jordan K Dunn K
Full Access

Background

Social context may be important in chronic pain. One focus is reactions to pain between persons with LBP and their partners. Researchers have investigated partner reactions and found influences on pain levels and psychological outcomes, but little is known about factors underpinning these reactions.

Aim

To investigate the associations of relationship quality and perceived partner responses with LBP intensity and disability.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 486 - 486
1 Nov 2011
Artus M van der Windt D Jordan K Hay E
Full Access

Objectives: To assess the evidence for a similar pattern of response to treatment among non-specific low back pain (NSLBP) patients in clinical trials.

Design: A systematic review of published trials on NSLBP and meta-analysis of within-group treatment effect calculated as the Standardised Mean Difference (SMD).

Data source: The Cochrane Register of Controlled Trials’ database (CENTRAL), April 2007.

Review methods: We included randomised controlled trials that investigated the effectiveness of primary care treatments in patients with NSLBP aged 18 years or over. We excluded trials conducted in patients with LBP of identifiable cause (e.g. disc herniation or arthritis), post-operative or post-traumatic back pain, or back pain during pregnancy or labour. We chose outcome measures commonly used in the majority of NSLBP trials, namely the Visual Analogue scale (VAS) for pain severity, Roland Morris Disability questionnaire (RMDQ) and Oswestry Disability questionnaire (ODQ) for physical functioning.

Results: 118 trials investigating a wide range of primary care treatment for NSLBP were included. In spite of heterogeneity, we found evidence for a similar pattern of symptom improvement represented by large SMDs at six weeks follow up ((0.86 for pain, 95% CI = 0.65,1.07, 0.97 for RMDQ, 95% CI = 0.66,1.28 and 0.98 for ODQ, 95% CI = 0.62,1.33) followed by much smaller further change at 13 week (pain 1.07 95% CI = 0.87,1.27, RMDQ 0.93 95% CI = 0.67,1.20, ODQ 0.92 95% CI = 0.70,1.14), 27 week (pain 1.03 95% CI = 0.82,1.25, RMDQ 0.91 95% CI = 0.59,1.24, ODQ 1.08 95% CI = 0.80,1.36 and 52 week (pain 0.88 95% CI = 0.60,1.1, RMDQ 1.01 95% CI = 0.68,1.34, ODQ 1.14 95% CI = 0.88,1.39). There was no statistically significant difference between responses in various trials arms (index treatment, active comparator treatment, placebo or sham treatment, usual care or waiting list controls). There was also no statistically significant difference between responses to pharmacological and non-pharmacological treatments.

Conclusions: NSLBP symptoms seem to improve very well and in a similar pattern in clinical trials following a wide variety of active as well as inactive treatments. It is important to explore factors other than the treatments themselves that might influence symptom improvement. Exploring possible sources of underlying heterogeneity in responses might lead to some of these factors.

Conflict of Interest: None

Source of Funding: This work is part of a PhD fellowship funded by the arc (Arthritis research campaign).