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Outpatients with Low Back Pain: An Analysis of the Rate Per Day of Pain Improvement That May Be Expected and Factors Affecting Improvement

Granger, Carl V. MD; Lackner, Jeffrey M. PsyD; Kulas, Margaret MS; Russell, Carol F. BA

American Journal of Physical Medicine & Rehabilitation: April 2003 - Volume 82 - Issue 4 - p 253-260
doi: 10.1097/01.PHM.0000057224.20987.2A
Research Articles: Low Back Pain

Granger CV, Lackner JM, Kulas M, Russell CF: Outpatients with low back pain: An analysis of the rate per day of pain improvement that may be expected and factors affecting improvement. Am J Phys Med Rehabil 2003;82:253–260.

Objective To determine, only for those who improved, the rate per day of improvement expected for outpatients with low back pain and to identify factors influencing pain improvement: pain duration before assessment, pain and physical functioning levels before assessment, age, sex, and affective factors. It was presupposed that affective factors would have an appreciable effect.

Design The LIFEware SystemSM database was used. Analysis was performed on 1292 records for the Painfree measure and 1562 records for the LIFEware System Visual Analog Scale. Measures for pain, physical functioning, and affective well-being were analyzed for 0–30 days vs. >30 days of pain duration before assessment using classification and regression trees analysis.

Results In both Painfree and LIFEware System Visual Analog Scale, 73% improved and 27% did not improve. Of those who improved, outpatients with 0–30 days of pain duration before assessment had higher per day rates of improvement than the >30 days group. Factors affecting improvement were, in descending order, more initial pain, younger age, and positive affective well-being; physical functioning did not affect rate of improvement. Factors affecting improvement for outpatients with >30 days since onset were, in descending order, more initial pain and better initial physical functioning; age and affective well-being were not factors. For all, neither sex nor the “satisfaction with life in general” question affected low back pain rate of improvement.

Conclusion Findings may be useful for clinical application because the actual rate of improvement may be compared with the expected rate. There was only a weak relationship shown between affective factors and pain improvement.

From the Department of Rehabilitation Medicine (CVG), Department of Medicine (JML), University at Buffalo, Buffalo, New York; the Uniform Data System for Medical Rehabilitation, Amherst, New York (CVG, MK, CFR); and Blue Cross and Blue Shield of WNY, Buffalo, New York (MK).

All correspondence and requests for reprints should be addressed to: Carl V. Granger, MD, UDSmr, 270 Northpointe Parkway, Suite 300, Amherst, NY 14228.

© 2003 Lippincott Williams & Wilkins, Inc.