Factors predicting return to work in chronic low back pain

January 01, 0001

Factors predicting return to work in chronic low back pain

Chronic low back pain (CLBP) can be a challenging condition that is frequently seen in primary care. These US researchers wanted to characterize the patients seen in primary care with these symptoms and to delineate factors that predicted difficulty with return to work. They enrolled 356 ambulatory patients with CLBP of at least 3 months duration Through the Residency Research Network of Texas. They measure the effect of pain using a Likert scale.

The researchers found: "Patients were typically female (72%), overweight or obese (mean body mass index, 33.4), had pain for many years (mean, 13.6 years), and screened positive for recent depressive symptoms (83%). The majority of patients took at least some opioid medication for their pain (59%). Multivariate linear regression analysis found that the largest single contributor to effect on work was the subjects' score on the SF-36 physical function scale. Other contributors included average daily pain, the frequency of flare-ups of pain, the effect of the painful flare-ups , and current depressive symptoms. Age, sex, race/ethnicity, total time the patient has had CLBP, other comorbidities (including a diagnosis of depression), disability status, use of opioids, history of intimate partner violence, social support, and procedures attempted were not predictive."

The researchers concluded: "Future studies attempting to demonstrate the effectiveness of interventions in CLBP should measure depressive symptoms and the magnitude and effect of painful flare-ups, not just the overall pain score. The majority of CLBP patients seen in these practices take opioids for their pain. Screening and treating for depression may be reasonable for some patients, though evidence of its effectiveness is lacking."

This study enumerates factors predicting difficulty with return to work in low back pain patients and reinforces the link of chronic back pain and depressive symptoms

For the full abstract, click here.

The Journal of the American Board of Family Medicine 24(5):503-510, September 2011 © 2011 American Board of Family Medicine
Factors Influencing Work Interference in Patients With Chronic Low Back Pain: A Residency Research Network of Texas (RRNeT) Study. Richard A. Young, Terrell Benold, John Whitham, and Sandra Burge. Correspondence to Richard A. Young: ryoung01@jpshealth.org

Category: M. Musculoskeletal. Keywords: low back pain, chronic, depression, work, opioids, survey, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 21 October 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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