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Chiropractic Research Review

Preventing Chronic Spinal Pain

Chronic low back pain is common in industrial societies and is a primary cause of work-related disability. Because of psychological factors and difficulty in locating pain-generating pathology in patients with chronic back pain, patients are often left to deal with the pain on their own.

Individual care may end up including the use of narcotic-strength medications.

Can chronic back pain be prevented through early identification of risk factors? This literature review examines potential contributors to chronicity and prolonged disability in the care of low back pain. World-recognized chronic pain guidelines are reviewed and practice aids are provided. Included is a thorough discussion of:

* the consequences of chronic back pain;
* pain behaviors and pain models;
* psychosocial "yellow flags";
* clinical assessment and assessment goals;
* physical examination findings leading to "red flags";
* integration of "yellow flags" into practice aids and protocols;
* risk factors and referral considerations; and
* suggestions for early behavioral management.

Identifying patients at risk for chronic back pain can be an important first step in decreasing the probability of chronicity, enhancing return to functional and work status, and positively affecting patient pain behaviors.

Hansen DT. Psychosocial predictors in spine care. Topics in Clinical Chiropractic, June 1999:6(2), pp38-50. Reprints: (800) 638-8437

Chiropractic Research Review

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