Nature and Determinants of the Course of Chronic Low Back Pain Over a 12-Month Period: A Cluster Analysis

BACKGROUND: It has been suggested that low back pain (LBP) is a condition with an unpredictable pattern of exacerbation, remission, and recurrence. However, there is an incomplete understanding of the course of LBP and the determinants of the course. OBJECTIVE: The purposes of this study were: (1) to identify clusters of LBP patients with similar fluctuating pain patterns over time and (2) to investigate whether demographic and clinical characteristics can distinguish these clusters. DESIGN: This study was a secondary analysis of data extracted from a randomized controlled trial. METHODS: Pain scores were collected from 155 participants with chronic nonspecific LBP. Pain intensity was measured monthly over a 1-year period by mobile phone short message service. Cluster analysis was used to identify participants with similar fluctuating patterns of pain based on the pain measures collected over a year, and t tests were used to evaluate if the clusters differed in terms of baseline characteristics. RESULTS: The cluster analysis revealed the presence of 3 main clusters. Pain was of fluctuating nature within 2 of the clusters. Out of the 155 participants, 21 (13.5%) had fluctuating pain. Baseline disability (measured with the Roland-Morris Disability Questionnaire) and treatment groups (from the initial randomized controlled trial) were significantly different in the clusters of patients with fluctuating pain when compared with the cluster of patients without fluctuating pain. LIMITATIONS: A limitation of this study was the fact that participants were undergoing treatment that may have been responsible for the rather positive prognosis observed. CONCLUSIONS: A small number of patients with fluctuating patterns of pain over time were identified. This number could increase if individuals with episodic pain are included in this fluctuating group.