central sensitization and chronicity: bits

risk assessment for chronification: education level, dissability
central sensitization
FMS/MFD/ANSDys/ less endogenous inhibitory pain pathways

Zung and Beck score, helplessness,catastrophizing,
HKF-R 10 - screening for predicting chronicity in acute low back pain (LBP): a prospective clinical trial. - Neubauer E - Eur J Pain - 01-AUG-2006; 10(6): 559-66 (From NIH/NLM MEDLINE)

Abstract:STUDY DESIGN: Prospective cohort study. OBJECTIVES: To develop a short instrument to reliably predict chronicity in low back pain (LBP). SUMMARY OF BACKGROUND DATA: Health care expenditures on the treatment of low back pain continue to increase. It is therefore important to prevent the development of chronicity. In Germany, there is at present no early risk assessment tool to predict the risk of developing chronic LBP for patients presenting with acute LBP. Undertaken in an orthopedic practice setting, this study examined known risk factors for chronicity. It resulted in the development of a short questionnaire that successfully predicted the course of chronicity with an accuracy of 78%. METHODS: A cohort of 192 orthopaedic outpatients was assessed for clinical, behavioral, emotional, and cognitive parameters bsed on a self-report test battery of 167 established items predictive for chronicity in LBP. Chronicity was defined as back pain persisting for longer than six months. Logistic regression analysis was performed to evaluate the predictive value of all items significantly associated with the dependent variable. RESULTS: The study found the following items to have the strongest predictive value in the development of chronicity: "How strong was your back pain during the last week when it was most tolerable?" and the question "How much residual pain would you be willing to tolerate while still considering the therapy successful?" These were followed by the variables for "Duration of existing LBP" (more than eight days), the patient's educational level (low levels are related to higher risks of chronicity) and pain being experienced elsewhere in the body. Other significant factors were five items assessing depression (Zung) and the palliative effect of therapeutic massage (where a positive correlation was found). Female patients have a higher risk for chronicity, as do patients with a high total score on the scales assessing "catastrophizing thoughts" and thoughts of "helplessness". CONCLUSION: Using the items listed above, the study was able to predict a patient's risk of developing chronic LBP with a probability of 78%. These items were assembled in a brief questionnaire and were paired with a corresponding evaluative tool. This enables practitioners to assess an individual patient's risk for chronicity by means of a simple calculator in just a few minutes. A validation study for the questionnaire is currently being prepared. MINI ABSTRACT: The objective of this study was the development of a brief questionnaire to assess the risk for chronicity for LBP.
Citation:HKF-R 10 - screening for predicting chronicity in acute low back pain (LBP): a prospective clinical trial.Neubauer E - Eur J Pain - 01-AUG-2006; 10(6): 559-66From NIH/NLM MEDLINE
NLM Citation ID:
Abstract:AIM: The objective of the study was to develop a brief questionnaire to determine the risk of chronification for patients suffering from lumbar (low) back pain who are consulting a physician for the first or second time. METHOD: At the outset, and again after six months, a questionnaire with 167 valid items for chronification was distributed to patients in orthopedic offices. After six months, patients were contacted by mail to inquire whether they were still suffering from back pain. Based on outcome (persistence of back pain/absence of back pain) and by means of logistic regression analysis, those variables were determined that could predict actual chronification. RESULTS: The following items were predictive: "How strong was your back pain during the last week when it was most tolerable?" and "How much residual pain would you be willing to tolerate while still considering the therapy successful?" (Acceptance value, beta = 0.61), patient's educational level (beta = - 0.44), massage is experienced as bringing relief (beta = 0.44), 5 items of the Zung scale for depression (beta = 0.42), items of the scale for catastrophizing thoughts (beta = 0.41) and items of the scale for feelings of helplessness (beta = - 0.39) of the Kiel pain inventory; duration of the back pain for longer than 1 week (beta = 0.38), pain in other parts of the body (beta = 0.37); and female gender (beta = 0.25) CONCLUSION: Based on these questions, it was possible to predict the chronification of back pain with a probability of 78.05 %. A corresponding questionnaire and an evaluative table were developed.
Citation:[What questions are appropriate for predicting the risk of chronic disease in patients suffering from acute low back pain?]Neubauer E - Z Orthop Ihre Grenzgeb - 01-MAY-2005; 143(3): 299-301From NIH/NLM MEDLINE
NLM Citation ID:15977118 (PubMed ID)
Full Source Title:Zeitschrift fur Orthopadie und ihre Grenzgebiete
Publication Type:Clinical Trial; English Abstract; Journal Article
Language:German
Author Affiliation:Orthopädische Universitätsklinik, Heidelberg.
Authors:Neubauer E; Pirron P; Junge A; Seemann H; Schiltenwolf M

Chemical Compound Name:Welche Fragen sind geeignet, ein Chronifizierungsrisiko von akuten Rückenschmerzen vorherzusagen? Eine prospektive klinische Studie.