ONE-YEAR FOLLOW-UP OF FIRST ONSET LOW-BACK-PAIN

Efforts to examine the process and risk of developing chronic back pai n have relied generally upon retrospective study of individuals with a lready established pain. In an alternative approach to understanding t he clinical course and evolution of low back disorders, a cohort of 76 men experiencing their first episode of back pain was assessed prospe ctively at 2, 6 and 12 months following pain onset, Standard measures of pain (Descriptor Differential Scale: DDS), disability (Sickness Imp act Profile: SIP), and distress (Beck Depression Inventory: BDI) were employed to classify the sample into five groups: Resolved: Pain Only, Disability/Distress Only, Pain and Mild Disability/Distress, and Clin ical Range, At both 6 and 12 months post pain onset, most (78%, 72% re spectively) of the sample continued to experience pain. Many also expe rienced marked disability at 6 months (26%) and 12 months (14%). At 12 months, no participants had worsened relative to the 2-month baseline . Doubly multivariate analyses of variance (MANOVAs) were employed to compare baseline groups (Pain Only, Pain and Mild Disability/Distress, Clinical Range) on the DDS, SIP, and BDI across time. The group by ti me interaction from 2 through 12 months was reliable, with greatest ch ange occurring in the Clinical Range group in disability and distress; interestingly, the decrease in pain was comparable among all groups. Follow-up tests across measures demonstrated greater change in the ear ly (2-6-month) interval and relative stability in the later (6-12-mont h) interval. Comparison of those classified as 'improvers' with those who did not improve from 2 to 12 months showed similar findings, The c linical course of first onset back pain may be prolonged for many pati ents, and involves a continuum of related disability and distress. Ind ividuals at risk for marked symptoms 1 year after an initial episode o f back pain can be identified early, and prompt treatment might reduce the risk of pain chronicity. (C) 1997 International Association for t he Study of Pain. Published by Elsevier Science B.V.