Top

Published in:

Open Access 01-01-2020 | Back Pain

The longitudinal relationships between pain severity and disability versus health-related quality of life and costs among chronic low back pain patients

Authors: E. N. Mutubuki, Y. Beljon, E. T. Maas, F. J. P. M. Huygen, R. W. J. G. Ostelo, M. W. van Tulder, J. M. van Dongen

Published in: Quality of Life Research | Issue 1/2020

Abstract

Purpose

Previous studies found higher levels of pain severity and disability to be associated with higher costs and lower health-related quality of life. However, these findings were based on cross-sectional data and little is known about the longitudinal relationships between pain severity and disability versus health-related quality of life and costs among chronic low back pain patients. This study aims to cover this knowledge gap by exploring these longitudinal relationships in a consecutive cohort.

Methods

Data of 6316 chronic low back pain patients were used. Measurements took place at 3, 6, 9, and 12 months. Pain severity (Numeric pain rating scale; range: 0–100), disability (Oswestry disability index; range: 0–100), health-related quality of life (EQ-5D-3L: range: 0–1), societal and healthcare costs (cost questionnaire) were measured. Using linear generalized estimating equation analyses, longitudinal relationships were explored between: (1) pain severity and health-related quality of life, (2) disability and health-related quality of life, (3) pain severity and societal costs, (4) disability and societal costs, (5) pain severity and healthcare costs, and (6) disability and healthcare costs.

Results

Higher pain and disability levels were statistically significantly related with poorer health-related quality of life (pain intensity: − 0.0041; 95% CI − 0.0043 to − 0.0039; disability: − 0.0096; 95% CI − 0.0099 to − 0.0093), higher societal costs (pain intensity: 7; 95% CI 5 to 8; disability: 23; 95% CI 20 to 27) and higher healthcare costs (pain intensity: 3; 95% CI 2 to 4; disability: 9; 95% CI 7 to 11).

Conclusion

Pain and disability were longitudinally related to health-related quality of life, societal costs, and healthcare costs. Disability had a stronger association with all outcomes compared to pain.

Available only for authorised users

Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., et al. (2018). What low back pain is and why we need to pay attention. The Lancet,391, 2356–2367.CrossRef

Hoy, D., March, L., Brooks, P., Woolf, A., Blyth, F., Vos, T., et al. (2010). Measuring the global burden of low back pain. Best Practice & Research Clinical Rheumatology,24(2), 155–165. https://doi.org/10.1016/j.berh.2009.11.002.CrossRef

Andersson, G. B. (1999). Epidemiological features of chronic low-back pain. Lancet,354(9178), 581–585. https://doi.org/10.1016/S0140-6736(99)01312-4.CrossRefPubMed

Krismer, M., van Tulder, M., & Low Back Pain Group of the Bone and Joint Health Strategies for Europe Project. (2007). Strategies for prevention and management of musculoskeletal conditions. Low back pain (non-specific). Best Practice & Research: Clinical Rheumatology,21(1), 77–91. https://doi.org/10.1016/j.berh.2006.08.004.CrossRef

Manchikanti, L., Singh, V., Datta, S., Cohen, S. P., Hirsch, J. A., & American Society of Interventional Pain Physicians. (2009). Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Physician,12(4), E35–E70.PubMed

Lambeek, L. C., van Tulder, M. W., Swinkels, I. C., Koppes, L. L., Anema, J. R., & van Mechelen, W. (2011). The trend in total cost of back pain in The Netherlands in the period 2002 to 2007. Spine (Phila Pa 1976),36(13), 1050–1058. https://doi.org/10.1097/brs.0b013e3181e70488.CrossRef

Smith, M., Davis, M. A., Stano, M., & Whedon, J. M. (2013). Aging baby boomers and the rising cost of chronic back pain: Secular trend analysis of longitudinal Medical Expenditures Panel Survey data for years 2000 to 2007. Journal of Manipulative and Physiological Therapeutics,36(1), 2–11. https://doi.org/10.1016/j.jmpt.2012.12.001.CrossRefPubMedPubMedCentral

Semeru, G. M., & Halim, M. S. (2019). Acceptance versus catastrophizing in predicting quality of life in patients with chronic low back pain. The Korean Journal of Pain,32(1), 22–29. https://doi.org/10.3344/kjp.2019.32.1.22.CrossRefPubMedPubMedCentral

Costa, L. D. C. M., Maher, C. G., McAuley, J. H., Hancock, M. J., Herbert, R. D., Refshauge, K. M., et al. (2009). Prognosis for patients with chronic low back pain: Inception cohort study. BMJ,339, b3829.CrossRefPubMedCentral

10.

Vlaeyen, J. W. S., Maher, C. G., Wiech, K., van Zundert, J., BeraldoMeloto, C., Diatchenko, L., et al. (2018). Low back pain. Nature Reviews Disease Primers,4, 52.CrossRefPubMed

11.

Vos, T., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., … & Aboyans, V. (2017). Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 390(10100), 1211–1259.

12.

Fredheim, O. M. S., Kaasa, S., Fayers, P., Saltnes, T., Jordhøy, M., & Borchgrevink, P. C. (2008). Chronic non-malignant pain patients report poor health related quality of life as palliative cancer patients. Acta Anaesthesiologica Scandinavica,52(1), 143–148.CrossRefPubMed

13.

Dieleman, J. L., Baral, R., Birger, M., Bui, A. L., Bulchis, A., Chapin, A., et al. (2016). US spending on personal health care and public health, 1996–2013. JAMA,316(24), 2627–2646.CrossRefPubMedPubMedCentral

14.

Katz, J. N. (2006). Lumbar disc disorders and low-back pain: Socioeconomic factors and consequences. Journal of Bone and Joint Surgery,88, 21–24.

15.

Tsuboi, Y., Murata, S., Naruse, F., & Ono, R. (2019). Association between pain-related fear and presenteeism among eldercare workers with low back pain. European Journal of Pain,23(3), 495–502.PubMed

16.

Sadosky, A. B., Taylor-Stokes, G., Lobosco, S., Pike, J., & Ross, E. (2013). Relationship between self-reported low-back pain severity and other patient-reported outcomes: Results from an observational study. Clinical Spine Surgery,26(1), 8–14.

17.

Horng, Y. S., Hwang, Y. H., Wu, H. C., Liang, H. W., Mhe, Y. J., Twu, F. C., et al. (2005). Predicting health-related quality of life in patients with low back pain. Spine (Phila Pa 1976),30(5), 551–555.CrossRef

18.

Von Korff, M., Crane, P., Lane, M., Miglioretti, D. L., Simon, G., Saunders, K., … & Kessler, R. (2005). Chronic spinal pain and physical–mental comorbidity in the United States: Results from the national comorbidity survey replication. Pain, 113(3), 331–339.

19.

Sadosky, A. B., DiBonaventura, M., Cappelleri, J. C., Ebata, N., & Fujii, K. (2015). The association between lower back pain and health status, work productivity, and health care resource use in Japan. Journal of Pain Research,8, 119.PubMedPubMedCentral

20.

Cedraschi, C., Luthy, C., Allaz, A. F., Herrmann, F. R., & Ludwig, C. (2016). Low back pain and health-related quality of life in community-dwelling older adults. European Spine Journal,25(9), 2822–2832. https://doi.org/10.1007/s00586-016-4483-7.CrossRefPubMed

21.

Chiarotto, A., Maxwell, L. J., Ostelo, R. W., Boers, M., Tugwell, P., & Terwee, C. B. (2019). Measurement properties of visual analogue scale, numeric rating scale, and pain severity subscale of the brief pain inventory in patients with low back pain: A systematic review. The Journal of Pain,20(3), 245–263. https://doi.org/10.1016/j.jpain.2018.07.009.CrossRefPubMed

22.

Twisk, J. W. R. (2013). Applied longitudinal data analysis for epidemiology. Cambridge: Cambridge University Press.CrossRef

23.

Maas, E. T., Juch, J. N., Groeneweg, J. G., Ostelo, R. W., Koes, B. W., Verhagen, A. P., et al. (2012). Cost-effectiveness of minimal interventional procedures for chronic mechanical low back pain: Design of four randomised controlled trials with an economic evaluation. BMC Musculoskelet Disord,13(1), 260. https://doi.org/10.1186/1471-2474-13-260.CrossRefPubMedPubMedCentral

24.

Juch, J. N., Maas, E. T., Ostelo, R. W., Groeneweg, J. G., Kallewaard, J.-W., Koes, B. W., et al. (2017). Effect of radiofrequency denervation on pain intensity among patients with chronic low back pain: The mint randomized clinical trials. JAMA,318(1), 68–81.CrossRefPubMedPubMedCentral

25.

Soer, R., Reneman, M. F., Speijer, B. L., Coppes, M. H., & Vroomen, P. C. (2012). Clinimetric properties of the EuroQol-5D in patients with chronic low back pain. Spine,12(11), 1035–1039. https://doi.org/10.1016/j.spinee.2012.10.030.CrossRef

26.

Lamers, L. M., Stalmeier, P. F., McDonnell, J., Krabbe, P. F., & van Busschbach, J. J. (2005). Measuring the quality of life in economic evaluations: The Dutch EQ-5D tariff. Nederlands Tijdschrift Voor Geneeskunde,149(28), 1574–1578.PubMed

27.

Whitehead, S. J., & Ali, S. (2010). Health outcomes in economic evaluation: The QALY and utilities. British Medical Bulletin,96(1), 5–21.CrossRefPubMed

28.

Goossens, M. E., Rutten-van Molken, M. P., Vlaeyen, J. W., & van der Linden, S. M. (2000). The cost diary: A method to measure direct and indirect costs in cost-effectiveness research. Journal of Clinical Epidemiology,53(7), 688–695.CrossRefPubMed

29.

Hakkaart-van Roijen, L., Van der Linden, N., Bouwmans, C., Kanters, T., & Tan, S. (2015). Costing manual: Methodology of costing research and reference prices for economic evaluations in healthcare. Diemen: Zorginstituut Nederland.

30.

Koopmanschap, M. A. (2005). PRODISQ: A modular questionnaire on productivity and disease for economic evaluation studies. Expert Rev Pharm Outcomes Res,5(1), 23–28. https://doi.org/10.1586/14737167.5.1.23.CrossRef

31.

Ferreira-Valente, M. A., Pais-Ribeiro, J. L., & Jensen, M. P. (2011). Validity of four pain intensity rating scales. Pain,152(10), 2399–2404. https://doi.org/10.1016/j.pain.2011.07.005.CrossRefPubMed

32.

Williamson, A., & Hoggart, B. (2005). Pain: A review of three commonly used pain rating scales. Journal of Clinical Nursing,14(7), 798–804.CrossRefPubMed

33.

Childs, J. D., Piva, S. R., & Fritz, J. M. (2005). Responsiveness of the numeric pain rating scale in patients with low back pain. Spine (Phila Pa 1976),30(11), 1331–1334.CrossRef

34.

Vianin, M. (2008). Psychometric properties and clinical usefulness of the Oswestry Disability Index. The Journal of Chiropractic Medicine,7(4), 161–163. https://doi.org/10.1016/j.jcm.2008.07.001.CrossRefPubMed

35.

Roland, M., & Fairbank, J. (2000). The Roland–Morris disability questionnaire and the Oswestry disability questionnaire. Spine (Phila Pa 1976),25(24), 3115–3124.CrossRef

36.

Fairbank, J. C., & Pynsent, P. B. (2000). The Oswestry disability index. Spine (Phila Pa 1976),25(22), 2940–2952.CrossRef

37.

Walsh, T. L., Hanscom, B., Lurie, J. D., & Weinstein, J. N. (2003). Is a condition-specific instrument for patients with low back pain/leg symptoms really necessary? The responsiveness of the Oswestry Disability Index, MODEMS, and the SF-36. Spine,28(6), 607–615.PubMed

38.

Ostelo, R. W., & de Vet, H. C. (2005). Clinically important outcomes in low back pain. Best Practice & Research Clinical Rheumatology,19(4), 593–607. https://doi.org/10.1016/j.berh.2005.03.003.CrossRef

39.

Chiarotto, A., Boers, M., Deyo, R. A., Buchbinder, R., Corbin, T. P., Costa, L. O. P., et al. (2018). Core outcome measurement instruments for clinical trials in nonspecific low back pain. Pain,159(3), 481–495. https://doi.org/10.1097/j.pain.0000000000001117.CrossRefPubMedPubMedCentral

40.

van Hooff, M. L., van Loon, J., van Limbeek, J., & de Kleuver, M. (2014). The Nijmegen decision tool for chronic low back pain. Development of a clinical decision tool for secondary or tertiary spine care specialists. PloS ONE,9(8), e104226.CrossRefPubMedPubMedCentral

41.

Devilly, G. J., & Borkovec, T. D. (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry,31(2), 73–86.CrossRefPubMed

42.

Davidson, M., & Keating, J. (2005). Oswestry disability questionnaire (ODQ). The Australian Journal of Physiotherapy,51(4), 270.CrossRefPubMed

43.

Rabin, R., & Charro, F. D. (2001). EQ-SD: A measure of health status from the EuroQol Group. Annals of Medicine,33(5), 337–343.PubMedCrossRef

44.

Brazier, J. E., Harper, R., Jones, N. M., O’Cathain, A., Thomas, K. J., Usherwood, T., et al. (1992). Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ,305(6846), 160–164. https://doi.org/10.1136/bmj.305.6846.160.CrossRefPubMedPubMedCentral

45.

Hays, R. D., & Morales, L. S. (2001). The RAND-36 measure of health-related quality of life. Annals of Medicine,33(5), 350–357.CrossRefPubMed

46.

Van der Zee, K. I., Heyink, J. W., & de Haes, H. (1996). Psychometric qualities of the RAND 36-item health survey 1.0: A multidimensional measure of general health status. International Journal of Behavioral Medicine,3(2), 104.CrossRef

47.

Lousberg, R., Van Breukelen, G. J., Groenman, N. H., Schmidt, A. J., Arntz, A., & Winter, F. A. (1999). Psychometric properties of the multidimensional pain inventory, Dutch language version (MPI-DLV). Behaviour Research and Therapy,37(2), 167–182.CrossRefPubMed

48.

McKillop, J. M., & Nielson, W. R. (2011). Improving the usefulness of the multidimensional pain inventory. Pain Research and Management,16(4), 239–244.CrossRefPubMedPubMedCentral

49.

Burton, A., Billingham, L. J., & Bryan, S. (2007). Cost-effectiveness in clinical trials: Using multiple imputation to deal with incomplete cost data. Clinical Trials,4(2), 154–161.CrossRefPubMed

50.

White, I. R., Royston, P., & Wood, A. M. (2011). Multiple imputation using chained equations: issues and guidance for practice. Statistics in Medicine,30(4), 377–399.CrossRefPubMed

51.

Luo, N., Johnson, J. A., & Coons, S. J. (2010). Using instrument-defined health state transitions to estimate minimally important differences for four preference-based health-related quality of life instruments. Medical Care,48(4), 365–371.CrossRefPubMed

52.

Walters, S. J., & Brazier, J. E. (2005). Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Quality of Life Research,14(6), 1523–1532.CrossRefPubMed

53.

Stefane, T., Santos, A. M. D., Marinovic, A., & Hortense, P. (2013). Chronic low back pain: Pain intensity, disability and quality of life. Acta Paulista de Enfermagem,26(1), 14–20.CrossRef

54.

Lamé, I. E., Peters, M. L., Vlaeyen, J. W., Kleef, M. V., & Patijn, J. (2005). Quality of life in chronic pain is more associated with beliefs about pain, than with pain intensity. European Journal of Pain,9(1), 15–24.CrossRefPubMed

55.

Sullivan, M. J., Bishop, S. R., & Pivik, J. (1995). The pain catastrophizing scale: Development and validation. Psychological Assessment,7(4), 524–532.CrossRef

56.

Picavet, H. S., Vlaeyen, J. W., & Schouten, J. S. (2002). Pain catastrophizing and kinesiophobia: Predictors of chronic low back pain. American Journal of Epidemiology,156(11), 1028–1034. https://doi.org/10.1093/aje/kwf136.CrossRefPubMed

57.

Henschke, N., Maher, C. G., Refshauge, K. M., Herbert, R. D., Cumming, R. G., Bleasel, J., et al. (2008). Prognosis in patients with recent onset low back pain in Australian primary care: Inception cohort study. BMJ,337(a171), a171. https://doi.org/10.1136/bmj.a171.CrossRefPubMed

58.

Mok, L. C., & Lee, I. F. (2008). Anxiety, depression and pain intensity in patients with low back pain who are admitted to acute care hospitals. Journal of Clinical Nursing,17(11), 1471–1480. https://doi.org/10.1111/j.1365-2702.2007.02037.x.CrossRefPubMed

59.

Linda Muller, J. F., Chkalova, k., Dankmeyer, B., Bloem, M. (2018). Monitor loonverschillen mannen en vrouwen, 2016. https://www.cbs.nl/nl-nl/maatwerk/2018/47/monitor-loonverschillen-mannen-en-vrouwen-2016.

60.

Wenig, C. M., Kohlmann, T., & Schweikert, B. (2009). Costs of back pain in Germany. European Journal of Pain,13(3), 280–286.CrossRefPubMed

61.

Herdman, M., Gudex, C., Lloyd, A., Janssen, M. F., Kind, P., Parkin, D., … & Badia, X (2011). Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Quality of Life Research, 20(10), 1727–1736.

62.

Janssen, M. F., Pickard, A. S., Golicki, D., Gudex, C., Niewada, M., Scalone, L., … & Busschbach, J (2013). Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study. Quality of Life Research, 22(7), 1717–1727.

Title: The longitudinal relationships between pain severity and disability versus health-related quality of life and costs among chronic low back pain patients
Authors: E. N. Mutubuki
Y. Beljon
E. T. Maas
F. J. P. M. Huygen
R. W. J. G. Ostelo
M. W. van Tulder
J. M. van Dongen
Publication date: 01-01-2020
Publisher: Springer International Publishing
Keywords: Back Pain
Back Pain
Back Pain
Published in: Quality of Life Research / Issue 1/2020
Print ISSN: 0962-9343
Electronic ISSN: 1573-2649
DOI: https://doi.org/10.1007/s11136-019-02302-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The longitudinal relationships between pain severity and disability versus health-related quality of life and costs among chronic low back pain patients

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2020

Quality of life in nursing home residents with pain: pain interference, depression and multiple pain-related diseases as important determinants

Reliability and validity of PROMIS® pediatric family relationships short form in children 8–17 years of age with chronic disease

Mapping EQ-5D-3L from the Knee Injury and Osteoarthritis Outcome Score (KOOS)

Health-related quality of life in children after laparoscopic gastrostomy placement

A validation study of the ICECAP-O in informal carers of people with dementia from eight European Countries

Hope predicted quality of life in dyads of community-dwelling patients receiving hemodialysis and their family caregivers