Low Back Pain in Time: Risk Factors Associated with Persistence, Recurrence, and Time Till Patients Seek Help in Primary Care

Abstract

Introduction Time characteristics of early episodes of low back pain (LBP) like duration and recurrence may relate to current risk factors and lack of resources that increase the risk of persistent LBP. In addition, when suffering from a first episode of LBP and individuals decide to seek medical care, time till individuals do should be not too long. Again, delay of presentation may relate to risk factors and lack of resources. Aim of our study was to estimate the relationship between time-related LBP characteristics and prognostic factors for acute/subacute LBP in primary care. Materials and Methods Prospective inception cohort study of 315 consecutive patients attending a health practitioner for their first episode of acute/subacute LBP or recurrent LBP. One-tailed correlations conducted between patient characteristics and the three time-related characteristics “subacute LBP”, “recurrent LBP,” and “delayed presentation”. Results The pattern of correlation between risk factors and resources against persistent LBP differed between three time-related variables. “Subacute LBP” and “delayed presentation” were positively associated with psychological factors (pain catastrophizing, magnification, and helplessness). Both indicators were negatively correlated with resources (job satisfaction and time control) against development of persistent LBP. Moreover, “delayed presentation” was related positively with occupational stressors (“resigned attitude towards the job”, “uncertainty”, “problem with organization of work tasks”, “work interruptions”). In contrast, “recurrent LBP” was only related to more impaired health-related factors (functional limitation, sensory, and affective pain). Conclusion Patients with current LBP waiting longer till seeking help in primary care have a more disadvantageous profile of occupational and psychological risk factors and lower resource levels. A similar but less pronounced pattern occurred in those with subacute LBP compared to those with acute LBP. Implications for clinical practice are twofold; (1) LBP-patients with prolonged symptoms or delayed care-seeking behavior, who are at risk of developing persistent LBP, should be screened for psychological factors such as magnification and helplessness, (2) In these patients, occupational resources like job satisfactionand time control should be addressed and strengthened in primary and secondary prevention, where feasible. Future research should examine time-related variables that influence prognostic factors for LBP in different clinical settings such as predominantly retired or unemployed populations. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared