Clinical course and prognostic factors across different musculoskeletal pain sites: A secondary analysis of individual patient data from randomised clinical trials

D.j. Green, M. Lewis, G. Mansell, M. Artus, K.s. Dziedzic, E.m. Hay, N.e. Foster, D.a. Van Der Windt

Research output: Contribution to journalArticle

Abstract

Background
Previous research has identified similar prognostic factors in patients with musculoskeletal (MSK) conditions regardless of pain presentation, generating opportunities for management based on prognosis rather than specific pain presentation.

Methods
Data from seven RCTs (2483 participants) evaluating a range of primary care interventions for different MSK pain conditions were used to investigate the course of symptoms and explore similarities and differences in predictors of outcome. The value of pain site for predicting changes in pain and function was investigated and compared with that of age, gender, social class, pain duration, widespread pain and level of anxiety/depression.

Results
Over the initial three months of follow‐up, changes in mean pain intensity reflected an improvement, with little change occurring after this period. Participants with knee pain due to osteoarthritis (OA) showed poorer long‐term outcome (mean difference in pain reduction at 12 months −1.85, 95% CI −2.12 to −1.57, compared to low back pain). Increasing age, manual work, longer pain duration, widespread pain and increasing anxiety/depression scores were significantly associated with poorer outcome regardless of pain site. Testing of interactions showed some variation between pain sites, particularly for knee OA, where age, manual work and pain duration were most strongly associated with outcome.

Conclusions
Despite some differences in prognostic factors for trial participants with knee OA who were older and had more chronic conditions, similarity of outcome predictors across regional MSK pain sites provides evidence to support targeting of treatment based on prognostic factors rather than site of pain.

Significance
Individual patient data analysis of trials across different regional musculoskeletal pain sites was used to evaluate course and prognostic factors associated with pain and disability. Overall, similarity of outcome predictors across these different pain sites supports targeting of treatment based on prognostic factors rather than pain site alone.
Original languageEnglish
Pages (from-to)1057-1070
JournalEuropean Journal of Pain
Volume22
Issue number6
Early online date22 Feb 2018
DOIs
Publication statusPublished - 11 Jun 2018

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Musculoskeletal Pain
Randomized Controlled Trials
Pain
Knee Osteoarthritis
Anxiety
Depression

Bibliographical note

This is the peer reviewed version of the following article: Green, D. , Lewis, M. , Mansell, G. , Artus, M. , Dziedzic, K. , Hay, E. , Foster, N. and Windt, D. (2018), Clinical course and prognostic factors across different musculoskeletal pain sites: A secondary analysis of individual patient data from randomised clinical trials. Eur J Pain, 22: 1057-1070, which has been published in final form at https://doi.org/10.1002/ejp.1190.  This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.

Funding: The project was supported by a grant (project no. 84) from the National Institute for Health Research (NIHR) School for Primary Care Research. DJG was funded by a NIHR School for Primary Care Research Doctoral Training Studentship; KD is part funded by the NIHR Collaborations for Leadership in Applied Research and Care West Midlands and by a Knowledge Mobilisation Research Fellowship (KMRF‐2014‐03‐002) from the NIHR; NF, an NIHR Senior Investigator, is supported through an NIHR Research Professorship (NIHR‐RP‐011‐015); DvdW is a member of PROGRESS Medical Research Council Prognosis Research Strategy (PROGRESS) Partnership (G0902393/99558); GM is supported by NIHR School for Primary Care Research Seedcorn Funding; EH is a NIHR Senior Investigator.

Cite this

Green, D.j. ; Lewis, M. ; Mansell, G. ; Artus, M. ; Dziedzic, K.s. ; Hay, E.m. ; Foster, N.e. ; Van Der Windt, D.a. / Clinical course and prognostic factors across different musculoskeletal pain sites: A secondary analysis of individual patient data from randomised clinical trials. In: European Journal of Pain. 2018 ; Vol. 22, No. 6. pp. 1057-1070.
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abstract = "BackgroundPrevious research has identified similar prognostic factors in patients with musculoskeletal (MSK) conditions regardless of pain presentation, generating opportunities for management based on prognosis rather than specific pain presentation.MethodsData from seven RCTs (2483 participants) evaluating a range of primary care interventions for different MSK pain conditions were used to investigate the course of symptoms and explore similarities and differences in predictors of outcome. The value of pain site for predicting changes in pain and function was investigated and compared with that of age, gender, social class, pain duration, widespread pain and level of anxiety/depression.ResultsOver the initial three months of follow‐up, changes in mean pain intensity reflected an improvement, with little change occurring after this period. Participants with knee pain due to osteoarthritis (OA) showed poorer long‐term outcome (mean difference in pain reduction at 12 months −1.85, 95{\%} CI −2.12 to −1.57, compared to low back pain). Increasing age, manual work, longer pain duration, widespread pain and increasing anxiety/depression scores were significantly associated with poorer outcome regardless of pain site. Testing of interactions showed some variation between pain sites, particularly for knee OA, where age, manual work and pain duration were most strongly associated with outcome.ConclusionsDespite some differences in prognostic factors for trial participants with knee OA who were older and had more chronic conditions, similarity of outcome predictors across regional MSK pain sites provides evidence to support targeting of treatment based on prognostic factors rather than site of pain.SignificanceIndividual patient data analysis of trials across different regional musculoskeletal pain sites was used to evaluate course and prognostic factors associated with pain and disability. Overall, similarity of outcome predictors across these different pain sites supports targeting of treatment based on prognostic factors rather than pain site alone.",
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Clinical course and prognostic factors across different musculoskeletal pain sites: A secondary analysis of individual patient data from randomised clinical trials. / Green, D.j.; Lewis, M.; Mansell, G.; Artus, M.; Dziedzic, K.s.; Hay, E.m.; Foster, N.e.; Van Der Windt, D.a.

In: European Journal of Pain, Vol. 22, No. 6, 11.06.2018, p. 1057-1070.

Research output: Contribution to journalArticle

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AU - Green, D.j.

AU - Lewis, M.

AU - Mansell, G.

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AU - Dziedzic, K.s.

AU - Hay, E.m.

AU - Foster, N.e.

AU - Van Der Windt, D.a.

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N2 - BackgroundPrevious research has identified similar prognostic factors in patients with musculoskeletal (MSK) conditions regardless of pain presentation, generating opportunities for management based on prognosis rather than specific pain presentation.MethodsData from seven RCTs (2483 participants) evaluating a range of primary care interventions for different MSK pain conditions were used to investigate the course of symptoms and explore similarities and differences in predictors of outcome. The value of pain site for predicting changes in pain and function was investigated and compared with that of age, gender, social class, pain duration, widespread pain and level of anxiety/depression.ResultsOver the initial three months of follow‐up, changes in mean pain intensity reflected an improvement, with little change occurring after this period. Participants with knee pain due to osteoarthritis (OA) showed poorer long‐term outcome (mean difference in pain reduction at 12 months −1.85, 95% CI −2.12 to −1.57, compared to low back pain). Increasing age, manual work, longer pain duration, widespread pain and increasing anxiety/depression scores were significantly associated with poorer outcome regardless of pain site. Testing of interactions showed some variation between pain sites, particularly for knee OA, where age, manual work and pain duration were most strongly associated with outcome.ConclusionsDespite some differences in prognostic factors for trial participants with knee OA who were older and had more chronic conditions, similarity of outcome predictors across regional MSK pain sites provides evidence to support targeting of treatment based on prognostic factors rather than site of pain.SignificanceIndividual patient data analysis of trials across different regional musculoskeletal pain sites was used to evaluate course and prognostic factors associated with pain and disability. Overall, similarity of outcome predictors across these different pain sites supports targeting of treatment based on prognostic factors rather than pain site alone.

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