AbstractIntroduction: The global burden of low back pain (LBP) is rising. Its clinical management has historically been informed by using duration-based classification. Recently, some guidelines have moved away from this approach, with little empirical evidence to justify this transition. This thesis aims to explore this gap by investigating the role of pain duration in the management of patients with LBP.
Methods: A scoping review explored the different working definitions for chronic pain. Then, short, medium, and long-term outcomes, including pain, function, quality-of-life, and re-referral rates for patients with LBP managed on an evidence-based pathway were analysed using covariate-adjusted models. Patients were categorized into four groups based upon baseline pain duration, informed by the scoping review.
Results: The scoping review concluded that there is a wide variation in pain duration definitions, with 3 months being the most common definition for chronic pain. In the short-term, patients with differing LBP duration improved by clinically relevant amounts. Medium-to-long term, those with longer pain duration showed less improvement, specifically in function. Furthermore, pain duration was found to be a relatively weak predictor of re-referral (odds ratio: 1.2 (95% CI: 1.03, 1.44); risk difference: 3.6% (95% CI: 0.6, 6.6)).
Conclusions and implications: While there is a lack of consensus in the literature on duration definitions, this thesis demonstrates that baseline pain duration would appear to be of clinical importance on patient outcomes. Those with chronic pain may benefit from additional support to enhance functional outcomes in the medium-to-long term. This could question the removal of duration as a factor to consider within clinical guidelines. Contrastingly, from a health-care usage perspective, as duration was not predictive of re-referral, pain duration seems of limited importance; arguably this supports the decision of guidelines to remove duration as a factor to differentiate the management of patients with LBP.
|Date of Award||3 Dec 2021|
|Supervisor||Cormac Ryan (Supervisor), Sharon Hamilton (Supervisor) & Shaun Wellburn (Supervisor)|