Background: The majority of patient burden associated with low back pain is experienced by those who unintentionally transition from acute to chronic pain. Currently, there are large gaps in what we know regarding 1) the percentage of patients who experience chronic low back pain and 2) the extent to which patient and clinical/practice characteristics can predict the transition to chronic low back pain.

Study Objective: The purpose of this study was to determine if researchers could identify those patients most likely to transition from acute to chromic low back pain. To do so they considered the impact of patient demographics, risk stratification groups using a standardized questionnaire and whether clinical care was consistent with LBP guideline recommendations.

Methods: Researchers evaluated 5233 patients with acute low back pain (LBP) over a six month period using a large cohort study that was conducted in conjunction with a large randomized clinical trial. Participants were divided into low, medium and high risk groups as indicated by a 9-item questionnaire called the Subgroups for Targeted Treatment Back tool (SBT).

Findings: Nearly one third of patients included in this study transitioned from acute LBP and chronic LBP. The SBT was able to accurately predict the risk of this transition. In addition, patients exposed to clinical care that was not aligned with current LBP guidelines were more likely to experience chronic low back pain. The ability to identify this sub-group of patients is significant for clinicians.

Conclusions: Results suggested that risk of transition from acute to chronic LBP can be estimated using SBT, although not all current practice guidelines recommend the use of stratification tools. The more frequently this tool is used in practice, the greater the data accumulation and the more valuable early identification becomes.

Implications: Clinicians should consider using the SBT questionnaire when evaluating patients with acute low back pain to help identify those patients who are most likely to transition to chronic pain. In addition, patients are more likely to have better outcomes if they receive early conservative care that is aligned with current guidelines. Both clinicians and patients benefit from the information about treatment and outcomes obtained from the SBT questionnaire. In addition, patient awareness increases clinical compliance. This is an important study that is available online for free and should be shared with payers, primary care physicians and employers.