Prospective Back Pain Trajectories or Retrospective Recall-Which Tells Us Most About the Patient?

Casper Nim; Aron S Downie; Alice Kongsted; Sasha L Aspinall; Steen Harsted; Luana Nyirö; Werner Vach

doi:10.1016/j.jpain.2024.104555

Prospective Back Pain Trajectories or Retrospective Recall-Which Tells Us Most About the Patient?

J Pain. 2024 May 6:104555. doi: 10.1016/j.jpain.2024.104555. Online ahead of print.

Authors

Casper Nim¹, Aron S Downie², Alice Kongsted³, Sasha L Aspinall⁴, Steen Harsted⁵, Luana Nyirö⁶, Werner Vach⁷

Affiliations

¹ Medical Research Unit, Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. Electronic address: casper.nim@rsyd.dk.
² Faculty of Medicine, Health and Human Sciences, Department of Chiropractic, Macquarie University, Sydney, Australia.
³ Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Chiropractic Knowledge Hub, Odense, Denmark.
⁴ School of Allied Health, College of Health and Education, Murdoch University, Perth, Australia.
⁵ Medical Research Unit, Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark; Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
⁶ Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zürich, Switzerland.
⁷ Basel Academy for Quality and Research in Medicine, Basel, Switzerland.

PMID: 38719157
DOI: 10.1016/j.jpain.2024.104555

Abstract

In patients with low back pain (LBP), a visually identified retrospective pain trajectory often mismatches with a trajectory derived from prospective repeated measures. To gain insight into the clinical relevance of the 2 trajectory types, we investigated which showed a higher association with clinical outcomes. Participants were 724 adults seeking care for LBP in Danish chiropractic primary care. They answered weekly short-message-services on pain intensity and frequency over 52 weeks, which we translated into 8 trajectory classes. After 52 weeks, participants selected a retrospective visual pain trajectory from the same 8 trajectory classes. Clinical outcomes included disability, back/leg pain intensity, back beliefs, and work ability. The patient-selected pain trajectory classes were more strongly associated with clinical outcomes than the short-message-service trajectory classes at baseline, at follow-up, and with outcome changes between baseline and follow-up. This held across all 5 clinical outcomes, with the strongest associations observed at week 52 and the weakest at baseline. Patients' retrospective assessment of their LBP is more strongly associated with their clinical status than their prospective assessments translated into trajectory classes. This suggests that retrospective assessments of pain trajectories may provide valuable information not captured by prospective assessments. Researchers collecting prospective pain data should know that the captured pain trajectories are not strongly reflected in patients' perceptions of clinical status. Patients' retrospective assessments seem to offer an interpretation of their pain course that is likely more clinically relevant in understanding the perceived impact of their condition than trajectories based on repeated measures. PERSPECTIVE: Prospective pain data inadequately reflect patients' clinical status. Retrospective assessments provide a more clinically valuable understanding of the impact of their condition.

Keywords: Low back pain; pain pattern; pain perception; pain trajectory; primary care.