Predicting the transition from acute to persistent low back pain

BACKGROUND: Most people experience low back pain (LBP) at least once in their lifetime. Only a minority of them go on to develop persistent LBP. However, the socioeconomic costs of persistent LBP significantly exceed the costs of the initial acute LBP episode. AIMS: To identify factors that influence the progression of acute LBP to the persistent state at an early stage. METHODS: Prospective inception cohort study of patients attending a health practitioner for their first episode of acute LBP or recurrent LBP after a pain free period of at least 6 months. Patients were assessed at baseline addressing occupational and psychological factors as well as pain, disability, quality of life and physical activity and followed up at 3, 6, 12 weeks and 6 months. Variables were combined to the three indices 'working condition', 'depression and maladaptive cognitions' and 'pain and quality of life'. RESULTS: The index 'depression and maladaptive cognitions' was found to be a significant baseline predictor for persistent LBP up to 6 months (OR 5.1; 95% CI: 1.04-25.1). Overall predictive accuracy of the model was 81%. CONCLUSIONS: In this study of patients with acute LBP in a primary care setting psychological factors at baseline correlated with a progression to persistent LBP up to 6 months. The benefit of including factors such as 'depression and maladaptive cognition' in screening tools is that these factors can be addressed in primary and secondary prevention.

Predicting the transition from acute to persistent low back pain

BACKGROUND: Most people experience low back pain (LBP) at least once in their lifetime. Only a minority of them go on to develop persistent LBP. However, the socioeconomic costs of persistent LBP significantly exceed the costs of the initial acute LBP episode. AIMS: To identify factors that influence the progression of acute LBP to the persistent state at an early stage. METHODS: Prospective inception cohort study of patients attending a health practitioner for their first episode of acute LBP or recurrent LBP after a pain free period of at least 6 months. Patients were assessed at baseline addressing occupational and psychological factors as well as pain, disability, quality of life and physical activity and followed up at 3, 6, 12 weeks and 6 months. Variables were combined to the three indices 'working condition', 'depression and maladaptive cognitions' and 'pain and quality of life'. RESULTS: The index 'depression and maladaptive cognitions' was found to be a significant baseline predictor for persistent LBP up to 6 months (OR 5.1; 95% CI: 1.04-25.1). Overall predictive accuracy of the model was 81%. CONCLUSIONS: In this study of patients with acute LBP in a primary care setting psychological factors at baseline correlated with a progression to persistent LBP up to 6 months. The benefit of including factors such as 'depression and maladaptive cognition' in screening tools is that these factors can be addressed in primary and secondary prevention.

Toward optimal early management after whiplash injury to lessen the rate of transition to chronicity: discussion paper 5

Expert debate and synthesis of research to inform future management approaches for acute whiplash disorders.

Miocene basin development and volcanism along a strike-slip to flat-slab subduction transition: Stratigraphy, geochemistry, and geochronology of the central Wrangell volcanic belt, Yakutat-North America collision zone

New geochronologic, geochemical, sedimentologic, and compositional data from the central Wrangell volcanic belt (WVB) document basin development and volcanism linked to subduction of overthickened oceanic crust to the northern Pacific plate margin. The Frederika Formation and overlying Wrangell Lavas comprise >3 km of sedimentary and volcanic strata exposed in the Wrangell Mountains of south-central Alaska (United States). Measured stratigraphic sections and lithofacies analyses document lithofacies associations that reflect deposition in alluvial-fluvial-lacustrine environments routinely influenced by volcanic eruptions. Expansion of intrabasinal volcanic centers prompted progradation of vent-proximal volcanic aprons across basinal environments. Coal deposits, lacustrine strata, and vertical juxtaposition of basinal to proximal lithofacies indicate active basin subsidence that is attributable to heat flow associated with intrabasinal volcanic centers and extension along intrabasinal normal faults. The orientation of intrabasinal normal faults is consistent with transtensional deformation along the Totschunda-Fairweather fault system. Paleocurrents, compositional provenance, and detrital geochronologic ages link sediment accumulation to erosion of active intrabasinal volcanoes and to a lesser extent Mesozoic igneous sources. Geochemical compositions of interbedded lavas are dominantly calc-alkaline, range from basaltic andesite to rhyolite in composition, and share geochemical characteristics with Pliocene-Quaternary phases of the western WVB linked to subduction-related magmatism. The U/Pb ages of tuffs and Ar-40/Ar-39 ages of lavas indicate that basin development and volcanism commenced by 12.5-11.0 Ma and persisted until at least ca. 5.3 Ma. Eastern sections yield older ages (12.5-9.3 Ma) than western sections (9.6-8.3 Ma). Samples from two western sections yield even younger ages of 5.3 Ma. Integration of new and published stratigraphic, geochronologic, and geochemical data from the entire WVB permits a comprehensive interpretation of basin development and volcanism within a regional tectonic context. We propose a model in which diachronous volcanism and transtensional basin development reflect progressive insertion of a thickened oceanic crustal slab of the Yakutat microplate into the arcuate continental margin of southern Alaska coeval with reported changes in plate motions. Oblique northwestward subduction of a thickened oceanic crustal slab during Oligocene to Middle Miocene time produced transtensional basins and volcanism along the eastern edge of the slab along the Duke River fault in Canada and subduction-related volcanism along the northern edge of the slab near the Yukon-Alaska border. Volcanism and basin development migrated progressively northwestward into eastern Alaska during Middle Miocene through Holocene time, concomitant with a northwestward shift in plate convergence direction and subduction collision of progressively thicker crust against the syntaxial plate margin.

Study protocol: Transition from localized low back pain to chronic widespread pain in general practice: identification of risk factors, preventive factors and key elements for treatment--a cohort study

Background Chronic localized pain syndromes, especially chronic low back pain (CLBP), are common reasons for consultation in general practice. In some cases chronic localized pain syndromes can appear in combination with chronic widespread pain (CWP). Numerous studies have shown a strong association between CWP and several physical and psychological factors. These studies are population-based cross-sectional and do not allow for assessing chronology. There are very few prospective studies that explore the predictors for the onset of CWP, where the main focus is identifying risk factors for the CWP incidence. Until now there have been no studies focusing on preventive factors keeping patients from developing CWP. Our aim is to perform a cross sectional study on the epidemiology of CLBP and CWP in general practice and to look for distinctive features regarding resources like resilience, self-efficacy and coping strategies. A subsequent cohort study is designed to identify the risk and protective factors of pain generalization (development of CWP) in primary care for CLBP patients. Methods/Design Fifty-nine general practitioners recruit consecutively, during a 5 month period, all patients who are consulting their family doctor because of chronic low back pain (where the pain is lasted for 3 months). Patients are asked to fill out a questionnaire on pain anamnesis, pain-perception, co-morbidities, therapy course, medication, socio demographic data and psychosomatic symptoms. We assess resilience, coping resources, stress management and self-efficacy as potential protective factors for pain generalization. Furthermore, we raise risk factors for pain generalization like anxiety, depression, trauma and critical life events. During a twelve months follow up period a cohort of CLBP patients without CWP will be screened on a regular basis (3 monthly) for pain generalization (outcome: incident CWP). Discussion This cohort study will be the largest study which prospectively analyzes predictors for transition from CLBP to CWP in primary care setting. In contrast to the typically researched risk factors, which increase the probability of pain generalization, this study also focus intensively on protective factors, which decrease the probability of pain generalization.

Axis I diagnoses and transition to psychosis in clinical high-risk patients EPOS project: prospective follow-up of 245 clinical high-risk outpatients in four countries

In selected samples, a considerable number of patients at clinical high risk of psychosis (CHR) are found to meet criteria for co-morbid clinical psychiatric disorders. It is not known how clinical diagnoses correspond to or even predict transitions to psychosis (TTP). Our aim was to examine distributions of life-time and current Axis I diagnoses, and their association with TTP in CHR patients.