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Researchers identify factors that appear to influence work interference in study of patients with chronic low back pain

Monday, December 19 2011 | Comments
Evidence Grade 0 What's This?
Decreased physical function, daily pain and pain flare-ups all appear to interfere with the ability to work in individuals who have chronic low back pain, based on findings from a prospective study.

The study was conducted in urban family medicine clinics in Texas that provide care to mostly minority, low-income patients.

In all, 360 adults with a diagnosis of chronic low back pain that had persisted for more than three months completed a survey that assessed demographic factors, pain severity, frequency and duration of pain episodes, physical functioning and general health status, social support and stress, anxiety, depression, alcohol and drug use and measures related to personal history. Information about the cause and duration of pain, treatments provided, comorbidities and body mass index (BMI) was collected from the patients' charts.

The study authors noted that the current analysis was based entirely on baseline data. A single question was used to measure the effect of pain on work: How much does pain interfere with your normal work (including both housework and paid work)?

Most of the participants were middle-aged females, and many were overweight or obese (mean BMI, 33.4 kg/m2). Fewer than one quarter were currently employed, and approximately half were on disability or were applying for it. Slightly more than half had incomes of less than $1,000 per month.

The patients' mean duration of back pain was 13.6 years. Almost two thirds of the participants reported their health status as fair or poor. The majority (83 percent) screened positive for depressive symptoms in the previous month, as assessed by the Patient Health Questionnaire-2 (PHQ-2), although only 42.2 percent had a documented diagnosis of depression or anxiety.

The chart review revealed that 58.5 percent of the participants had some exposure to opioid drugs and 26.1 percent took them daily.

Two thirds of the patients reported experiencing pain every day. The participants' mean daily pain score was 6.8 on a 10-point scale, with 10 indicating the most severe pain.

In addition, 96.6 percent of the participants said they had experienced pain flare-ups in the previous year that had resulted in major restrictions in their daily activities, including 36 percent who said the flare-ups prevented them from working, 21 percent who said they had been unable to get out of bed and 19 percent who said they had needed assistance with basic routine activities.

Most of the pain variables assessed had a significant correlation to the effect of pain on work, according to bivariate analyses. Age, sex and comorbidities other than chronic obstructive pulmonary disease and depression, however, did not.

According to multivariate analyses, the largest single contributor to the effect of pain on work was the measure of physical function, as assessed by the Short Form-36 health survey. Other significant contributors included the measure of average daily pain and two measures associated with pain flare-ups. Having score greater than 2 on the PHQ-2, indicating recent depressive symptoms, also was a significant predictor of the effect on work, but having a diagnosis of depression in the patient chart was not. Demographic factors, duration of chronic low back pain, disability status, opioid use and attempted pain treatments also were not predictive.

The study authors emphasized that pain flare-ups interfered with the patients' ability to work at least as much as average daily pain did and advised that if a goal of treatment is to have individuals return to the workforce, then significant flare-ups "must decrease both in frequency and severity, and patients must be psychologically better equipped to function despite the pain."

This research was published in the September/October issue of the Journal of the American Board of Family Medicine.

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