Temporal stability of self-reported visual back pain trajectories

Casper Glissmann Nim, Alice Kongsted, Aron Downie, Werner Vach, Casper Glissmann Nim, Alice Kongsted, Aron Downie, Werner Vach

Abstract

Low back pain (LBP) follows different pain trajectories, and patients seem to recognize their trajectory. This allows self-reported visual pain trajectories (SRVTs) to support patient-provider communication. Pain trajectories appear stable over time for many patients, but the evidence is sparse. Our objectives were to investigate the (1) temporal stability of SRVTs over 1 year concerning pain intensity and course patterns and (2) association of transitions between SRVTs and changes in pain and disability. This study used data from 2 prospective primary care cohorts: the Danish Chiropractic LBP Cohort (n = 1323) and the GLA:D Back cohort (n = 1135). Participants identified one of the 8 SRVTs at baseline and 12-month follow-up, each asking about LBP trajectories the preceding year. Trajectories were described using 2 subscales (intensity and pattern). Temporal stability was quantified by "stability odds ratios" (ORs), depicting the likelihood of staying in the same SRVT after 12 months compared with baseline, and by "preference ORs," depicting the likelihood of choosing a specific alternative SRVT at follow-up. Both ORs compare the observed proportion with the chance level. Finally, we examined associations between transitioning to a different trajectory and changes in clinical outcomes. Approximately 30% stayed in the same SRVT. The stability ORs were all >1. The preference ORs indicated that transitions occurred mainly to similar SRVTs differing in only 1 subscale. Transitions to less or more intense SRVTs were associated with changes in clinical outcomes in the expected direction. Despite distinctly different SRVTs identified, individuals reported relatively stable LBP phenotypes but with potential for change.

Conflict of interest statement

A. Kongsted's position at the University of Southern Denmark is financially supported by the Danish Chiropractic Fund for Research and Postgraduate Research. The remaining authors declare no conflicts of interest.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Association for the Study of Pain.

Figures

Figure 1.
Figure 1.
Study flow of participants consenting to participate in 2 primary care cohorts.
Figure 2.
Figure 2.
Distribution of self-reported visual pain trajectories at baseline and after 12-month follow-up in 2 primary care cohorts. SRVT, self-reported visual pain trajectory.
Figure 3.
Figure 3.
Sankey diagrams showing the proportions of participants in each self-reported visual pain trajectory at baseline and follow-up for the ChiCo and GLA:D Back cohorts. The height of the bars and lines represents the number of participants.
Figure 4.
Figure 4.
Stability odds ratios of the 8 self-reported visual pain trajectories and the classes defined by the intensity and pattern subscales. The y-axis is illustrated on a logarithmic scale, and the numbers indicate the number of participants staying. SRVT, self-reported visual pain trajectory.
Figure 5.
Figure 5.
Preference odds ratios of transitioning from 1 self-reported visual pain trajectory at baseline to another at follow-up. The figure shows preference odds ratios for each possible transition with the number of participants who transition in brackets. SRVT, self-reported visual pain trajectory.
Figure 6.
Figure 6.
Clinical changes across transitioning to different self-reported visual pain trajectory patterns. Results are illustrated as mean values. A higher negative score indicates more improvement. Numbers next to the bar indicate the number of participants. SRVT, self-reported visual pain trajectory.

References

    1. Ahlstrom L, Grimby-Ekman A, Hagberg M, Dellve L. The work ability index and single-item question: associations with sick leave, symptoms, and health–a prospective study of women on long-term sick leave. Scand J Work Environ Health 2010;36:404–12.
    1. Ailliet L, Rubinstein SM, Hoekstra T, van Tulder MW, de Vet HCW. Long-term trajectories of patients with neck pain and low back pain presenting to chiropractic care: a latent class growth analysis. Eur J Pain 2018;22:103–13.
    1. Albert HB, Jensen AM, Dahl D, Rasmussen MN. Criteria validation of the Roland Morris questionnaire. A Danish translation of the international scale for the assessment of functional level in patients with low back pain and sciatica [in Danish]. Ugeskr Laeger 2003;165:1875–80.
    1. Axén I, Leboeuf-Yde C. Trajectories of low back pain. Best Pract Res Clin Rheumatol 2013;27:601–12.
    1. Broadbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. J Psychosom Res 2006;60:631–7.
    1. Bunzli S, Smith A, Schütze R, O'Sullivan P. Beliefs underlying pain-related fear and how they evolve: a qualitative investigation in people with chronic back pain and high pain-related fear. BMJ Open 2015;5:e008847.
    1. Chen Y, Campbell P, Strauss VY, Foster NE, Jordan KP, Dunn KM. Trajectories and predictors of the long-term course of low back pain: cohort study with 5-year follow-up. PAIN 2018;159:252–60.
    1. Downie AS, Hancock MJ, Rzewuska M, Williams CM, Lin C-WC, Maher CG. Trajectories of acute low back pain: a latent class growth analysis. PAIN 2016;157:225–34.
    1. Dunn KM, Campbell P, Jordan KP. Long-term trajectories of back pain: cohort study with 7-year follow-up. BMJ Open 2013;3:e003838.
    1. Dunn KM, Campbell P, Jordan KP. Validity of the visual trajectories questionnaire for pain. J Pain 2017;18:1451–8.
    1. Dutmer AL, Schiphorst Preuper HR, Stewart RE, Soer R, Reneman MF, Wolff AP. Trajectories of disability and low back pain impact. Spine 2020;45:1649–60.
    1. Grøn S, Jensen RK, Jensen TS, Kongsted A. Back beliefs in patients with low back pain: a primary care cohort study. BMC Musculoskelet Disord 2019;20:578.
    1. Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J 2003;12:149–65.
    1. Hestbaek L, Munck A, Hartvigsen L, Jarbøl DE, Søndergaard J, Kongsted A. Low back pain in primary care: a description of 1250 patients with low back pain in Danish general and chiropractic practice. Int J Fam Med 2014;2014:106102.
    1. Hestbaek L, Myburgh C, Lauridsen HH, Boyle E, Kongsted A. Contrasting real time quantitative measures (weekly SMS) to patients' retrospective appraisal of their one-year's course of low back pain; a probing mixed-methods study. Chiropr Man Therap 2019;27:12.
    1. Hill JC, Dunn KM, Lewis M, Mullis R, Main CJ, Foster NE, Hay EM. A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis Rheum 2008;59:632–41.
    1. Holt N, Pincus T, Vogel S. Reassurance during low back pain consultations with GPs: a qualitative study. Br J Gen Pract 2015;65:e692–701.
    1. Irgens P, Kongsted A, Myhrvold BL, Waagan K, Engebretsen KB, Natvig B, Vøllestad NK, Robinson HS. Neck pain patterns and subgrouping based on weekly SMS-derived trajectories. BMC Musculoskelet Disord 2020;21:678.
    1. Irgens P, Myhrvold BL, Kongsted A, Waagan K, Engebretsen KB, Vøllestad NK, Robinson HS. The clinical course of neck pain: are trajectory patterns stable over a 1-year period? Eur J Pain 2021;26:531–42.
    1. Itz CJ, Geurts JW, van Kleef M, Nelemans P. Clinical course of non-specific low back pain: a systematic review of prospective cohort studies set in primary care. Eur J Pain 2013;17:5–15.
    1. Kongsted A, Hartvigsen J, Boyle E, Ris I, Kjaer P, Thomassen L, Vach W. GLA:D® Back: group-based patient education integrated with exercises to support self-management of persistent back pain—feasibility of implementing standardised care by a course for clinicians. Pilot Feasibility Stud 2019;5:65.
    1. Kongsted A, Hestbæk L, Kent P. How can latent trajectories of back pain be translated into defined subgroups? BMC Musculoskelet Disord 2017;18:285.
    1. Kongsted A, Kent P, Axen I, Downie AS, Dunn KM. What have we learned from ten years of trajectory research in low back pain? BMC Musculoskelet Disord 2016;17:220.
    1. Kongsted A, Kent P, Hestbaek L, Vach W. Patients with low back pain had distinct clinical course patterns that were typically neither complete recovery nor constant pain. A latent class analysis of longitudinal data. Spine J 2015;15:885–94.
    1. Kongsted A, Nielsen OL, Christensen HW, Hartvigsen J, Doktor K, Kent P, Jensen TS. The Danish chiropractic low back pain cohort (ChiCo): description and summary of an available data source for research collaborations. Clin Epidemiol 2020;12:1015–27.
    1. Mun CJ, Suk HW, Davis MC, Karoly P, Finan P, Tennen H, Jensen MP. Investigating intraindividual pain variability: methods, applications, issues, and directions. PAIN 2019;160:2415–29.
    1. Myhrvold BL, Irgens P, Robinson HS, Engebretsen K, Natvig B, Kongsted A, Vøllestad NK. Visual trajectory pattern as prognostic factors for neck pain. Eur J Pain 2020;24:1752–64.
    1. Myhrvold BL, Kongsted A, Irgens P, Robinson HS, Thoresen M, Vollestad NK. Broad external validation and update of a prediction model for persistent neck pain after 12 weeks. [miscellaneous article]. Spine 2019:44.
    1. Patrick Dl, Ra Deyo, Atlas Sj, Singer De, Chapin A, Keller Rb. Assessing health-related quality of life in patients with sciatica. Spine (Phila Pa 1976) 1995;20:1899–1908.
    1. R Development Core Team. R: A Language and Environment for Statistical Computing. 2009. Available at: .
    1. Ris I, Broholm D, Hartvigsen J, Andersen TE, Kongsted A. Adherence and characteristics of participants enrolled in a standardised programme of patient education and exercises for low back pain, GLA:D® Back - a prospective observational study. BMC Musculoskelet Disord 2021;22:473.
    1. Silva Tda, Mills K, Brown BT, Pocovi N, Campos Tde, Maher C, Hancock MJ. Recurrence of low back pain is common: a prospective inception cohort study. J Physiother 2019;65:159–65.
    1. Sjoberg D. Ggsankey. 2021. Available at: . Accessed November 25, 2021.
    1. Sjoberg D, Curry M, Hannum M, Larmarange J, Whiting K, Zabor E, Drill E, Flynn J, Lavery J, Lobaugh S, Wainberg G. Presentation-Ready Data Summary and Analytic Result Tables [R package gtsummary version 1.4.1]. 2021. Available at: . Accessed May 25, 2021.
    1. What to notify? Available at: . Accessed March 28, 2020.
    1. Wickham H, Averick M, Bryan J, Chang W, McGowan L, François R, Grolemund G, Hayes A, Henry L, Hester J, Kuhn M, Pedersen T, Miller E, Bache S, Müller K, Ooms J, Robinson D, Seidel D, Spinu V, Takahashi K, Vaughan D, Wilke C, Woo K, Yutani H. Welcome to the Tidyverse. J Open Source Softw 2019;4:1686.

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