• Wolf E Mehling, Mark H Ebell, Andrew L Avins, and Frederick M Hecht.
• Department of Family Medicine, University of California-San Francisco, 1545 Divisadero St, San Francisco, CA 94115, USA; Osher Center for Integrative Medicine, University of California-San Francisco, 1545 Divisadero St, 4th Floor, San Francisco, CA 94115, USA. Electronic address: mehlingw@ocim.ucsf.edu.
• Spine J. 2015 Jul 1;15(7):1577-86.

Background ContextPrimary care clinicians need to identify candidates for early interventions to prevent patients with acute pain from developing chronic pain.PurposeWe conducted a 2-year prospective cohort study of risk factors for the progression to chronic pain and developed and internally validated a clinical decision rule (CDR) that stratifies patients into low-, medium-, and high-risk groups for chronic pain.Study Design/SettingThis is a prospective cohort study in primary care.Patient SamplePatients with acute low back pain (LBP, ≤30 days duration) were included.Outcome MeasuresOutcome measures were self-reported perceived nonrecovery and chronic pain.MethodsPatients were surveyed at baseline, 6 months, and 2 years. We conducted bivariate and multivariate regression analyses of demographic, clinical, and psychosocial variables for chronic pain outcomes, developed a CDR, and assessed its performance by calculating the bootstrapped areas under the receiver-operating characteristic curve (AUC) and likelihood ratios.ResultsSix hundred five patients enrolled: 13% had chronic pain at 6 months and 19% at 2 years. An eight-item CDR was most parsimonious for classifying patients into three risk levels. Bootstrapped AUC was 0.76 (0.70-0.82) for the 6-month CDR. Each 10-point score increase (60-point range) was associated with an odds ratio of 11.1 (10.8-11.4) for developing chronic pain. Using a less than 5% probability of chronic pain as the cutoff for low risk and a greater than 40% probability for high risk, likelihood ratios were 0.26 (0.14-0.48) and 4.4 (3.0-6.3) for these groups, respectively.ConclusionsA CDR was developed that may help primary care clinicians classify patients with strictly defined acute LBP into low-, moderate-, and high-risk groups for developing chronic pain and performed acceptably in 1,000 bootstrapped replications. Validation in a separate sample is needed.Copyright © 2015 Elsevier Inc. All rights reserved.

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