Clinical decision rule for primary care patient with acute low back pain at risk of developing chronic pain

doi:10.1016/j.spinee.2015.03.003

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Spine J. Author manuscript; available in PMC 2016 Jul 1.

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Spine J. 2015 Jul 1; 15(7): 1577–1586.

Published online 2015 Mar 13. doi: 10.1016/j.spinee.2015.03.003

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Table 1

Prediction Items

Numbers in parenthesis refer to item numbers in instruments. L: Linton’s ÖMPSQ¹¹; H: Heidelberger Kurzfragebogen^14,51
Clinical questions related to LBP
When did your pain start? (L7)	Days
Did it ever go below the knee?	y/n
Does it today go below the knee most of the time?	y/n
How would you rate the average (H5) pain you have had during the past week? (L8)	0–10
How would you rate the pain you have had during the past week when it was most tolerable? (H6) (“…the pain you had since it began?” if answer to L7 is <1 week)	0–10
How much pain would you be willing to tolerate and still consider the therapy successful? (H7)	0–10
Are you on sick leave because of pain?	y/n
If yes: How many days? (L5)	Days
Have you been on sick leave before for back pain?	y/n
On how many days during the past week did back or leg pain (sciatica) cause you to cut down for more than half of the day on things you usually do?	Days
On how many days during the past week did back or leg pain (sciatica) cause you to stay in bed for more than half the day?	Days
On how many days during the past week did back or leg pain (sciatica) cause you to loose days from work or school for more than half the day?	Days
Do you have pain in other parts of your body in addition to your back pain? (H4)	y/n
Do you have pain in the □ neck □ shoulders □ upper back
McGill Pain Questionnaire¹⁸
Roland Morris Disability Questionnaire (RMDQ) ⁵² for function or disability	0–24
Do you smoke?	y/n
If yes: More than 10 cigarettes per day?	y/n
ÖMPSQ and HKF-R10 items^11,51,53
Is your work heavy or monotonous? (L4)	0–10
Based on all the things you do to cope or deal with your pain, on an average day, how much are you able to decrease it? (L11)	0–10
I can do light work for an hour. (L12)	0–10
I can walk for an hour (L13)	0–10
I can do ordinary household chores (L14)	0–10
I can do the weekly shopping (L15)	0–10
I can sleep at night (L16)	0–10
How tense or anxious have you felt in the past week? (L17)	0–10
How much have you been bothered by feeling down or depressed in the past week? (L18/H10a)	0–10
Did you cry a lot or feel like crying in the past week? (H10b)	0–10
I still enjoy doing things I liked before (H10e)	0–10
In your view, how large is the risk that your current pain may become persistent (may not go away)? (L19)	0–10
In your estimation, what are the chances that you will be working in 6 months? (L20)	0–10
If you take into consideration your work routines, management, salary, promotion possibilities, and work mates, how satisfied are you with your job? (L21)	0–10
Physical activities make my pain worse (L22)	0–10
In your view from past experience, does massage bring pain relief? (H8)	y/n/dk
An increase in pain is an indication that I should stop what I am doing until the pain is decreasing (L23)	0–10
I should not do my normal work with my present pain (L24)	0–10
If you were aware of pain during the last week, how often did you have the following thoughts and feelings?(H9)
g I cannot stand it any longer!	0–10
h I wonder whether I have the same bad disease as…	0–10
m How much longer do I have to endure this pain?	0–10
n I wonder whether there is a bad disease behind all of this pain?	0–10
2-item Version of Coping Strategies Questionnaire (CSQ-2i)²¹
Parameters: diverting attention (1 mental positive thinking); reinterpreting pain sensations + detachment (2, 9); catastrophizing (3 magnification); ignoring sensations (4, 11); praying (5); coping self-statements (6, 13 challenge appraisal, endurance); increased behavioral activity (7, 14 active/passive distraction). “People who experience pain have developed a number of ways to deal with their pain. When you feel pain, how much do you do the following:
1. I think of things I enjoy doing	0–10
2. I just think of it as some other sensation, such as numbness	0–10
3. It is terrible and I feel it is never going to get any better	0–10
4. I don’t pay any attention to it	0–10
5. I pray for the pain to stop	0–10
6. I tell myself I can’t let the pain stand in the way of what I have to do	0–10
7. I do something active, like household chores or projects	0–10
9. I pretend it is not a part of me	0–10
11. I ignore it	0–10
13. I see it as a challenge and don’t let it bother me	0–10
14. I do something I enjoy, such as watching TV or listening to music	0–10
More coping items from CPCI²⁵ on “asking for assistance” (42); “seeking social support” (6); CRSS/KPI^28,54 (68) (introduction as in CSQ)
CPCI 42. I ask for help in carrying, lifting or pushing something	0–10
CPCI 6. I make arrangements to see a friend or family member	0–10
KPI 68. I have somebody console me	0–10
KPI 26+66. I talk with my partner or family	0–10
Selected PCS-items²³ for catastrophizing: magnification (13), rumination (9), and helplessness (2)
“If you were aware of pain during the last week, how often did you have the following thoughts and feelings?”
13) I wonder whether something serious may happen	0–10
9) I can’t seem to keep the pain out of my mind	0–10
2) I feel I can’t go on	0–10
Two work-related fear avoidance items from FABQ²²:
3) Physical activity such as bending, lifting, walking or driving might harm my back	0–10
11) My normal work might harm my back	0–10
2-item version of self-efficacy for pain subscale²¹ from Arthritis Self-Efficacy Scale (ASES)
As of now, how certain are you that you can decrease your pain quite a bit?	0–10
As of now, how certain are you that you can continue most of your daily activities?	0–10
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