Impact of psychosocial characteristics in neck and low back pain : Long-term outcome and prognosis concerning sick leave
Author: Bergström, Cecilia
Date: 2011-11-25
Location: Hörsal Farmakologi, Nanna Svartz väg 2, Karolinska Institutet, Solna
Time: 10.00
Department: Institutet för miljömedicin / Institute of Environmental Medicine
Abstract
Background: Neck pain (NP) and low back pain (LBP) are common, disabling and extremely costly health
issues in the industrial world, and the problem does not seem to be declining. Previously, it was thought that
NP/LBP would resolve within three months; however, it is now well established that NP and LBP are both
recurrent and episodic in nature. Of even greater concern, back pain seems to first appear in early adolescence to
reach the same levels as the adult population already at the age of 18. Psychosocial factors seem to influence the
onset of pain. There is also increasing evidence that psychosocial factors may play a crucial role in the transition
from acute and sub-acute pain to chronicity. Relevant clinical subgrouping, early identification of individuals
suffering from NP/LBP and prevention of chronicity has thus become a principal objective in today’s NP/LBP
research.
Aims: The overall aim of this thesis was to evaluate two classification methods for individuals with NP and/or
LBP. One based on psychosocial factors and one based on pain and pain related sick leave regarding their
ability to predict future sickness absence and disability pension among individuals with NP and/or LBP.
The primary aim of study I was to evaluate the ability of a classification method based on the Swedish version
of the Multidimensional Pain Inventory (MPI-S) to predict rehabilitation outcome (sick leave) among chronic
neck and back pain patients for a period of seven years after multidisciplinary rehabilitation. A secondary aim
was to use the MPI-subgroup information in conjunction with other clinical data, in this case sickness absence
prior to rehabilitation, in order to investigate future sickness absence and disability pension. The third aim was
to evaluate the economic outcome of rehabilitation across the defined patient groups.
In study II, the overall objective was to evaluate the predictive validity of a subgroup classification based the
MPI-S among gainfully employed workers with NP and LBP during follow-up periods of 18 and 36-months.
The overall aim in study III was to evaluate the potential interaction between treatment content and MPI-S
patient characteristic in the prediction of sickness absence during a 10-year follow-up.
The primary aim of study IV was to evaluate a mass screening method to identify individuals with NP/LBP
regarded ‘at-risk’ of future long-term sickness absence and disability pension.
Results: Individuals with pronounced psychosocial difficulties have more sickness absence compared to
patients with less pronounced psychosocial difficulties and better pain coping abilities. Further, subgroups based
on psychosocial characteristics had different prognoses with regard to sickness absence during the follow-up
periods. Patients with chronic NP/LBP appear to respond better to multidisciplinary rehabilitation compared to
its single components and patients with less psychosocial difficulties appear to respond most favourably.
Moreover, a classification method based on basic pain characteristics is effective in identifying individuals with
an increased risk of future long-term sickness absence and disability pension.
Conclusion: Altogether, these studies contribute to research in this area as they add to a better understanding of
relevant subgroups. Multidisciplinary rehabilitation appears to be more advantageous compared to its single
components in patients with chronic back pain with regard to future sickness absence. Furthermore, early
targeting of individuals considered ‘at-risk’ for future sickness absence and in need of further
investigation/interventions for their NP/LBP is valuable as it may significantly reduce individual suffering as
well as health care costs, which are important objectives for the Swedish health care system.
List of papers:
I. Bergström, G, Bergström C, Hagberg J, Bodin L, Jensen I. A 7-year follow-up of multidisciplinary rehabilitation among chronic neck and back pain patients. Is sick leave outcome dependent on psychologically derived patient groups? Eur J Pain 2010 Apr 14(4): 426-433.
Fulltext (DOI)
Pubmed
View record in Web of Science®
II. Bergström, C, Hagberg J, Bodin L, Jensen I, Bergström G. Using a psychosocial subgroup assignment to predict sickness absence in a working population with neck and back pain. BMC Musculoskelet Disord 2011 12: 81.
Fulltext (DOI)
Pubmed
View record in Web of Science®
III. Bergström, C, Jensen I, Hagberg J, Busch H, Bergström G. Effectiveness of different interventions using a psychosocial subgroup assignment in chronic neck and back pain patients – a 10-year follow-up. Disability & Rehabilitation. [Accepted]
Pubmed
View record in Web of Science®
IV. Bergström, C, Hagberg J, Jensen I, Bergström G. Evaluation of a simple mass screening method for identification of individuals with neck and/or low back pain considered ‟at-risk‟ for future sickness absence. [Submitted]
I. Bergström, G, Bergström C, Hagberg J, Bodin L, Jensen I. A 7-year follow-up of multidisciplinary rehabilitation among chronic neck and back pain patients. Is sick leave outcome dependent on psychologically derived patient groups? Eur J Pain 2010 Apr 14(4): 426-433.
Fulltext (DOI)
Pubmed
View record in Web of Science®
II. Bergström, C, Hagberg J, Bodin L, Jensen I, Bergström G. Using a psychosocial subgroup assignment to predict sickness absence in a working population with neck and back pain. BMC Musculoskelet Disord 2011 12: 81.
Fulltext (DOI)
Pubmed
View record in Web of Science®
III. Bergström, C, Jensen I, Hagberg J, Busch H, Bergström G. Effectiveness of different interventions using a psychosocial subgroup assignment in chronic neck and back pain patients – a 10-year follow-up. Disability & Rehabilitation. [Accepted]
Pubmed
View record in Web of Science®
IV. Bergström, C, Hagberg J, Jensen I, Bergström G. Evaluation of a simple mass screening method for identification of individuals with neck and/or low back pain considered ‟at-risk‟ for future sickness absence. [Submitted]
Institution: Karolinska Institutet
Supervisor: Bergström, Gunnar
Issue date: 2011-11-02
Rights:
Publication year: 2011
ISBN: 978-91-7457-531-6
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