Factors predicting the transition from acute to persistent pain in people with 'sciatica': the FORECAST longitudinal prognostic factor cohort study protocol

Annina B Schmid; Lucy Ridgway; Louise Hailey; Mohamed Tachrount; Fay Probert; Kathryn R Martin; Whitney Scott; Geert Crombez; Christine Price; Claire Robinson; Soraya Koushesh; Sarim Ather; Brigitte Tampin; Marco Barbero; Daniel Nanz; Stuart Clare; Jeremy Fairbank; Georgios Baskozos

doi:10.1136/bmjopen-2023-072832

Factors predicting the transition from acute to persistent pain in people with 'sciatica': the FORECAST longitudinal prognostic factor cohort study protocol

BMJ Open. 2023 Apr 5;13(4):e072832. doi: 10.1136/bmjopen-2023-072832.

Authors

Annina B Schmid^{1

2}, Lucy Ridgway³, Louise Hailey^{3

4}, Mohamed Tachrount^{3

2}, Fay Probert⁵, Kathryn R Martin^{6

7}, Whitney Scott^{8

9}, Geert Crombez¹⁰, Christine Price¹¹, Claire Robinson¹¹, Soraya Koushesh³, Sarim Ather¹², Brigitte Tampin^{13

14

15}, Marco Barbero¹⁶, Daniel Nanz^{17

18}, Stuart Clare^{3

2}, Jeremy Fairbank⁴, Georgios Baskozos³

Affiliations

¹ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK annina.schmid@neuro-research.ch.
² Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, Oxfordshire, UK.
³ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK.
⁴ Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK.
⁵ Department of Chemistry, University of Oxford, Oxford, Oxfordshire, UK.
⁶ Academic Primary Care, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
⁷ Aberdeen Centre for Arhtritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
⁸ Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁹ INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
¹⁰ Department of Experimental Clinical and Health Psychology, University of Ghent, Gent, Belgium.
¹¹ Patient partner FORECAST study, Oxford University, Oxford, UK.
¹² Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.
¹³ Department of Physiotherapy, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
¹⁴ Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
¹⁵ Faculty of Business and Social Sciences, University of Applied Sciences, Osnabrueck, Germany.
¹⁶ Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Ticino, Switzerland.
¹⁷ Swiss Center for Musculoskeletal Imaging, Balgrist Campus AG, Zurich, Zurich, Switzerland.
¹⁸ Medical Faculty, University of Zurich, Zurich, Zurich, Switzerland.

Abstract

Introduction: Sciatica is a common condition and is associated with higher levels of pain, disability, poorer quality of life, and increased use of health resources compared with low back pain alone. Although many patients recover, a third develop persistent sciatica symptoms. It remains unclear, why some patients develop persistent sciatica as none of the traditionally considered clinical parameters (eg, symptom severity, routine MRI) are consistent prognostic factors.The FORECAST study (factors predicting the transition from acute to persistent pain in people with 'sciatica') will take a different approach by exploring mechanism-based subgroups in patients with sciatica and investigate whether a mechanism-based approach can identify factors that predict pain persistence in patients with sciatica.

Methods and analysis: We will perform a prospective longitudinal cohort study including 180 people with acute/subacute sciatica. N=168 healthy participants will provide normative data. A detailed set of variables will be assessed within 3 months after sciatica onset. This will include self-reported sensory and psychosocial profiles, quantitative sensory testing, blood inflammatory markers and advanced neuroimaging. We will determine outcome with the Sciatica Bothersomeness Index and a Numerical Pain Rating Scale for leg pain severity at 3 and 12 months.We will use principal component analysis followed by clustering methods to identify subgroups. Univariate associations and machine learning methods optimised for high dimensional small data sets will be used to identify the most powerful predictors and model selection/accuracy.The results will provide crucial information about the pathophysiological drivers of sciatica symptoms and may identify prognostic factors of pain persistence.

Ethics and dissemination: The FORECAST study has received ethical approval (South Central Oxford C, 18/SC/0263). The dissemination strategy will be guided by our patient and public engagement activities and will include peer-reviewed publications, conference presentations, social media and podcasts.

Trial registration number: ISRCTN18170726; Pre-results.

Keywords: Chronic Pain; Neurological injury; Neurological pain; Neurology; Rehabilitation medicine; Rheumatology.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Humans
Longitudinal Studies
Low Back Pain*
Prognosis
Prospective Studies
Quality of Life
Sciatica* / diagnosis

Abstract

Publication types

MeSH terms

Grants and funding