OBJECTIVES: To test whether the prognostic definition of chronic pain, which has previously been applied in specific anatomic areas, performed well in a cohort of older adults with a range of musculoskeletal pain sites. METHODS: Data are taken from the Prognostic Research Study of adults aged 50 years and above consulting their general practitioner with any musculoskeletal pain, who completed postal surveys immediately after consultation and 12 months later. Baseline risk of clinically significant pain persisting at 12 months' follow-up, defined as a Chronic Pain Grade ≥II, was calculated using the prognostic approach, which includes a range of pain and related factors. The approach was implemented using logistic regression models, and the performance of the approach, including cutoffs in the score to define groups with differing levels of risk, was assessed in terms of calibration and discrimination. RESULTS: Application of the original risk cutoffs created groups with increasing proportions of chronic pain (area under the curve =0.79). However, the probability of chronic pain in each group was higher than expected by the model. New cutoffs were defined for this group of older adults: score ≤5=probability of chronic pain <20%, ≤11=probability <50%, ≤16=probability <80%, which resulted in good calibration of the model. DISCUSSION: The prognostic approach to defining chronic pain is suitable for use in older adults consulting primary care with musculoskeletal pain at a range of sites, but new cutoffs are needed to allow for the higher risk profile in this group. An adapted version of this method may also have the potential for application directly within the clinical consultation.
OBJECTIVES: To test whether the prognostic definition of chronic pain, which has previously been applied in specific anatomic areas, performed well in a cohort of older adults with a range of musculoskeletal pain sites. METHODS: Data are taken from the Prognostic Research Study of adults aged 50 years and above consulting their general practitioner with any musculoskeletal pain, who completed postal surveys immediately after consultation and 12 months later. Baseline risk of clinically significant pain persisting at 12 months' follow-up, defined as a Chronic Pain Grade ≥II, was calculated using the prognostic approach, which includes a range of pain and related factors. The approach was implemented using logistic regression models, and the performance of the approach, including cutoffs in the score to define groups with differing levels of risk, was assessed in terms of calibration and discrimination. RESULTS: Application of the original risk cutoffs created groups with increasing proportions of chronic pain (area under the curve =0.79). However, the probability of chronic pain in each group was higher than expected by the model. New cutoffs were defined for this group of older adults: score ≤5=probability of chronic pain <20%, ≤11=probability <50%, ≤16=probability <80%, which resulted in good calibration of the model. DISCUSSION: The prognostic approach to defining chronic pain is suitable for use in older adults consulting primary care with musculoskeletal pain at a range of sites, but new cutoffs are needed to allow for the higher risk profile in this group. An adapted version of this method may also have the potential for application directly within the clinical consultation.
Authors: Jonathan C Hill; David G T Whitehurst; Martyn Lewis; Stirling Bryan; Kate M Dunn; Nadine E Foster; Kika Konstantinou; Chris J Main; Elizabeth Mason; Simon Somerville; Gail Sowden; Kanchan Vohora; Elaine M Hay Journal: Lancet Date: 2011-09-28 Impact factor: 79.321
Authors: Christian D Mallen; George Peat; Elaine Thomas; Simon Wathall; Tracy Whitehurst; Charlotte Clements; Joanne Bailey; Jacqueline Gray; Peter R Croft Journal: BMC Musculoskelet Disord Date: 2006-11-10 Impact factor: 2.362
Authors: Richard A Deyo; Samuel F Dworkin; Dagmar Amtmann; Gunnar Andersson; David Borenstein; Eugene Carragee; John Carrino; Roger Chou; Karon Cook; Anthony Delitto; Christine Goertz; Partap Khalsa; John Loeser; Sean Mackey; James Panagis; James Rainville; Tor Tosteson; Dennis Turk; Michael Von Korff; Debra K Weiner Journal: Phys Ther Date: 2015-02
Authors: Richard A Deyo; Samuel F Dworkin; Dagmar Amtmann; Gunnar Andersson; David Borenstein; Eugene Carragee; John Carrino; Roger Chou; Karon Cook; Anthony DeLitto; Christine Goertz; Partap Khalsa; John Loeser; Sean Mackey; James Panagis; James Rainville; Tor Tosteson; Dennis Turk; Michael Von Korff; Debra K Weiner Journal: J Pain Date: 2014-04-29 Impact factor: 5.820
Authors: Richard A Deyo; Samuel F Dworkin; Dagmar Amtmann; Gunnar Andersson; David Borenstein; Eugene Carragee; John Carrino; Roger Chou; Karon Cook; Anthony DeLitto; Christine Goertz; Partap Khalsa; John Loeser; Sean Mackey; James Panagis; James Rainville; Tor Tosteson; Dennis Turk; Michael Von Korff; Debra K Weiner Journal: Eur Spine J Date: 2014-10 Impact factor: 3.134
Authors: Paul Campbell; Jonathan C Hill; Joanne Protheroe; Ebenezer K Afolabi; Martyn Lewis; Ruth Beardmore; Elaine M Hay; Christian D Mallen; Bernadette Bartlam; Benjamin Saunders; Danielle A van der Windt; Sue Jowett; Nadine E Foster; Kate M Dunn Journal: J Pain Res Date: 2016-10-14 Impact factor: 3.133
Authors: Alison B Rushton; David W Evans; Nicola Middlebrook; Nicola R Heneghan; Charlotte Small; Janet Lord; Jaimin M Patel; Deborah Falla Journal: BMJ Open Date: 2018-04-28 Impact factor: 2.692
Authors: Richard A Deyo; Samuel F Dworkin; Dagmar Amtmann; Gunnar Andersson; David Borenstein; Eugene Carragee; John Carrino; Roger Chou; Karon Cook; Anthony DeLitto; Christine Goertz; Partap Khalsa; John Loeser; Sean Mackey; James Panagis; James Rainville; Tor Tosteson; Dennis Turk; Michael Von Korff; Debra K Weiner Journal: Int J Ther Massage Bodywork Date: 2015-09-01