Staging patients with chronic Low Back Pain: a first step in stratified pain treatment.

Abstract Background: The Mainz Pain Staging System (MPSS) is a multi-dimensional measure of pain chronicity stage (I-III). Staging Low Back Pain (LBP) patients may contribute for outcome prediction and may allow patients and professionals to formulate a management plan and to identify referral patients for pain treatment facilities. Aims: to analyze the characteristics of LBP patients at different chronicity-stage and to verify whether the MPSS stage may predict their outcome. Methods: we enrolled consecutive n=242 patients with LBP who were followed for ~60 days at 20 days interval being T1 the admission day and T4 the 60th day after admission. The MPSS was administered at T1 while the BPI from T1 to T4. Measures for analysis were patients' demographics, MPSS stage and BPI item scores. 2 analysis was used to assess associations between chronicity and independent variables; T-student test was used for BPI scores comparisons. Results: MPSS stage (I-III) proportions were: 7,9%, 41,3% and 50,8%, respectively. Statistically significant associations were found between MPSS-III stage and females; and, between MPSS-I and young adults and tall patients. Among MPSS-II/III patients, pain interference with most Quality of Life items significantly decreased over time while some scores of pain intensity in the past 24h significantly decreased only among MPSS-I/II patients. Conclusions: caregiver may expect poor pain relief among LBP MPSS-III patients. However, continuous multidisciplinary approach significantly improves these patient's quality of life. Outcome prediction using the MPSS may have wide implications for public health initiatives through identifying risk for poor prognosis and screening referral patients.