Psychiatric disorders and risk of transition to chronicity in men with first onset low back pain
Department of Family Medicine and Community Health
Adolescent; Adult; Chronic Disease; Humans; Low Back Pain; Male; Mental Disorders; Middle Aged; Pain Measurement; Psychiatric Status Rating Scales; Risk Factors; Tobacco Use Disorder; Young Adult
Community Health and Preventive Medicine | Preventative Medicine | Primary Care
OBJECTIVE: To assess whether pre-existing psychiatric diagnoses increase the likelihood of transitioning from sub-acute to chronic back pain. DESIGN: Prospective cohort study.
METHODS: Men (N = 140) experiencing a first onset of low back pain (LBP) were examined for lifetime psychiatric disorders approximately 8 weeks post pain-onset using the Diagnostic Interview Schedule (DIS-III-R), then re-evaluated at 6 months after pain onset to determine who did or did not progress to pain chronicity.
OUTCOME MEASURE: Transition to chronic pain and disability was based on 6-month self-report measures of pain intensity and perceived disability.
RESULTS: Men with a pre-pain lifetime diagnosis of major depressive disorder had 5 times greater risk of transitioning to chronic LBP (odds ratio [OR] = 4.99; 95% confidence interval [CI] 1.49-16.76). Increased risk was also associated with a pre-pain lifetime diagnosis of generalized anxiety (OR = 2.45; 95% CI 1.06-5.68), post-traumatic stress (OR = 3.23; 95% CI 1.11-9.44), and with current nicotine dependence (OR = 2.49; 95% CI 1.15-5.40). There were no statistically significant effects for abuse or dependence of alcohol or other psychoactive substances.
DISCUSSION: Lifetime history of major depression or a major anxiety disorder may represent potential psychosocial "yellow flags" for the transition to chronicity in men with first-onset LBP. Screening for lifetime depressive or anxiety disorders may identify individuals at higher risk, who may benefit from referral for more intensive rehabilitation.
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Citation: 2010 Aug 23. Link to article on publisher's site
Shaw, William S.; Means-Christensen, Adrienne J.; Slater, Mark A.; Webster, John S.; Patterson, Thomas L.; Grant, Igor; Garfin, Steven R.; Wahlgren, Dennis R.; Patel, Shetal; and Atkinson, J. Hampton, "Psychiatric disorders and risk of transition to chronicity in men with first onset low back pain" (2010). Family Medicine and Community Health Publications and Presentations. Paper 221.