by clicking the arrows at the side of the page, or by using the toolbar.
by clicking anywhere on the page.
by dragging the page around when zoomed in.
by clicking anywhere on the page when zoomed in.
web sites or send emails by clicking on hyperlinks.
Email this page to a friend
Search this issue
Index - jump to page or section
Archive - view past issues
Chiropractic Journal of Australia : CJA September 2013
Chiropractic Journal of Australia Volume 43 Number 3 September 2013 93 INTRODUCTION Low back pain (LBP) is the most costly and the most common musculoskeletal condition in industrialised countries, and is the most common cause of disability particularly for those under the age of 45.1-3 In the United States, it is estimated that LBP accounts for 11 billion dollars in lost wages annually, while simulation models suggest that the total cost may be greater than 20 billion dollars per year.4 In Australia, the estimated combined (direct and indirect) Chiropr J Aust 2013;43: 93-8. Transition from Acute to Chronic Low Back Pain: A Biopsychosocial Perspective FRANK DONNOLI and MICHAEL F. AZARI Frank Donnoli, BAppSc(Chiro), GradDipArts, GradDipPsych, MEd Discipline of Chiropractic, School of Health Sciences Michael F. Azari, BAppSc(Chiro), BSc(Hons), PhD Discipline of Chiropractic, School of Health Sciences Health Innovations Research Institute, RMIT University Received: 10 April 2013, accepted with revisions: 17 June 2013 Confict of Interest Statement: The authors have no confict of interest with regards to this manuscript. Abstract: Introduction: Low back pain (LBP) is the most costly and the most common musculoskeletal condition in industrialised countries, and is the most common cause of disability particularly for those under the age of 45. Most of disability and the associated costs relate to the condition when it becomes chronic. It is therefore necessary to study the factors that lead to chronicity, and the clinical predictors that can be used to warn clinicians against such an outcome. This review explores these predictors, as well as the beliefs and perceptions of practitioners about these predictors that inform their clinical decision-making that could impact on the patients' transition to chronicity. A number of these predictors of chronicity in LBP are beginning to be established, they include: Pain predictors: earlier literature categorises these predictors into three levels, primary or preinjury, secondary or pre chronicity and tertiary or chronic outcome predictors. Literature in recent times has pointed to psychological factors as being clearly associated with the development of chronicity. Disease related factors: Few associations have been identifed between the disease related factors and chronicity. Occupational factors: have been found to contribute signifcantly to the risk of chronicity. Workers with subacute LBP receiving workers compensation reported that stress, fear and beliefs about work correlated strongly with progression to chronicity. Psychological factors: with adverse bearing on prognosis have been identifed in most studies, psychological profle at presentation has a much stronger infuence on outcome than does conventional clinical information and Psychosocial factors: the way people "deal with the demands and challenges of everyday life" in a number of studies these have been reported to be associated with development of chronicity and have been defned as “yellow fags”. Practitioners' beliefs and perceptions: each profession dealing with chronic pain has its own knowledge base and beliefs about the causes and treatment of chronic LBP that are based on training, group perceptions, clinical experience and memory. These factors can have an impact on the progression to chronicity. Decision making: the literature on decision making processes has demonstrated that there are many factors that may bias a decision; these include accommodation bias, past experience and cognitive biases, the decisions as to which strategy to use in the treatment of LBP may be similarly wrought with these factors. Conclusion: According to much of the literature, chronicity in LBP is more closely related to demographic, psychological and occupational factors. It is important to have an understanding of these factors in order to manage LBP patients more effectively. In addition it may be instructive to examine the sources and content of continuing education that are available to practitioners. INDEX TERMS: loW back paIN; pSychology; caSE MaNagEMENT. cost of LBP is in excess of 9 billion dollars per annum.5 In the U.S., musculoskeletal impairment is the most prevalent impairment in people up to 65 years of age, and spinal impairments the most frequently reported subcategory of musculoskeletal impairment.6 A survey, by Walker and co-workers in 2004, of 3000 Australian adults estimated the point prevalence of LBP at 25.5%, six month period prevalence at 64.6% and lifetime prevalence at 79.2%.7 It has been estimated that in any one year approximately 3-4% of the population in all industrialised countries experience a temporarily disabling episode of LBP and that more than 1% of the working age population is permanently disabled by this problem.1 Only about 5% of sufferers seek medical advice, and most of them respond to conservative treatment. However, approximately 10% of those who experience an acute attack of LBP in the general population go on to become chronic pain sufferers.8 This review explores the evidence for the factors that are associated with, or may have an infuence in, the transition from acute to chronic LBP. It also examines the way practitioners involved in
CJA June 2013
CJA December 2013