Back pain is among the most frequently reported health problems in the world. New research published in Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals, examines patterns in back pain over time and identifies the patient characteristics and the extent of healthcare and medication use (including opioids) associated with different patterns.
The study included a representative sample of the Canadian population that was followed from 1994 to 2011. A total of 12,782 participants were interviewed every two years and provided data on factors including comorbidities, pain, disability, opioid and other medication use, and healthcare visits.
During the 16 years of follow-up, almost half (45.6 percent) of participants reported back pain at least once. There were four trajectories of pain among these participants: persistent (18 percent), developing (28.1 percent), recovery (20.5 percent), and occasional (33.4 percent).
The persistent and developing groups tended to have more pain and disability, as well as more healthcare visits and medication use than those in the recovery and occasional trajectory groups. The recovery trajectory group increased the use of opioids and antidepressants over time.
"The good news is that one in five people with back pain recovered; however, they continued to use opioids and antidepressants, suggesting that people recovering from back pain need ongoing monitoring," said lead author Mayilee Canizares, PhD, of the University Health Network's Krembil Research Institute in Toronto, Canada. "The bad news was that one in five experienced persistent back pain, with an additional group--almost one in three--who developed back pain over time. These two groups were associated with greater pain limiting activity, disability, and depression, as well as increased healthcare and medication use."
Dr. Canizares noted that the findings suggest that people with back pain are a heterogeneous group that may benefit from different approaches to management rather than a traditional one size fits all approach. "The distinct groups identified in the study may represent opportunities for more individualized treatment and preventative strategies," she said.
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Full Citation: "The course of back pain in the Canadian population: trajectories, predictors, and outcomes." Mayilee Canizares, Y. Raja Rampersaud, and Elizabeth M. Badley. Arthritis Care & Research; Published Online: January 14, 2019 (DOI: 10.1002/acr.23811).
Disclosures: YRR reports personal consulting fees from Medtronic, which have no impact on the findings of this study. MC and EMB have no financial disclosures.
Arthritis Care & Research is an official journal of the American College of Rheumatology (ACR), and the Association of Rheumatology Health Professionals (ARHP), a division of the College. Arthritis Care & Research is a peer-reviewed journal that publishes both original research and review articles that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with arthritis and related disorders, major topics are evidence-based practice studies, clinical problems, practice guidelines, health care economics, health care policy, educational, social, and public health issues, and future trends in rheumatology practice. The journal is published by Wiley on behalf of the ACR. For more information, please visit the journal home page at http://wileyonlinelibrary.com/journal/acr.
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