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Recovery trajectories in common musculoskeletal complaints by diagnosis contra prognostic phenotypes

PainSci » bibliography » Aasdahl et al 2021
updated
Tags: back pain, neck, shoulder, fibromyalgia, pain problems, spine, head/neck, chronic pain

One page on PainSci cites Aasdahl 2021: Diagnosis or the patient? What matters more for prognosis

PainSci commentary on Aasdahl 2021: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Aasdahl et al. studied how things went for 127 people with five common problems with no specific cause: pain in the neck, back, shoulder, or everywhere (“complex pain,” AKA fibromyalgia). So they were grouped by diagnosis. Imagine you put a couple dozen people with serious chronic back pain all in a room together. It probably wouldn’t take them long to figure out that they were all back pain patients.

And their prognosis? Predictably unpredictable, and mostly not great on average, with function improving modestly over a year, and pain somewhat less so.

But Aasdahl et al. also used a fancier sorting hat to group people by their traits from “across the biopsychosocial domains” — anything that has ever been considered a likely factor in prognosis, like pain intensity, activity level, sleep problems, mental distress, and many others. (This method comes from a complex prior study, Meisingset et al).

Put everyone in one of these groups into a room together and they might never figure out what they have in common! But they would have more predictable outcomes for any of the conditions studied … for better or worse.

In this study, prognosis was affected less by the kind of pain a person had, and more affected by the kind of person living with it.

I wrote a little more about the implications in a blog post.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: There are large variations in symptoms and prognostic factors among patients sharing the same musculoskeletal (MSK) diagnosis, making traditional diagnostic labelling not very helpful in informing treatment or prognosis. Recently, we identified five MSK phenotypes across common MSK pain locations through latent class analysis (LCA). The aim of this study was to explore the one-year recovery trajectories for pain and functional limitations in the phenotypes and describe these in relation to the course of traditional diagnostic MSK groups.

METHODS: We conducted a longitudinal observational study of 147 patients with neck, back, shoulder or complex pain in primary health care physiotherapy. Data on pain intensity and function were collected at baseline (week 0) and 1, 2, 3, 4, 6, 8, 12, 26 and 52 weeks of follow up using web-based questionnaires and mobile text messages. Recovery trajectories were described separately for the traditional diagnostic MSK groups based on pain location and the same patients categorized in phenotype groups based on prognostic factors shared among the MSK diagnostic groups.

RESULTS: There was a general improvement in function throughout the year of follow-up for the MSK groups, while there was a more modest decrease for pain intensity. The MSK diagnoses were dispersed across all five phenotypes, where the phenotypes showed clearly different trajectories for recovery and course of symptoms over 12 months follow-up. This variation was not captured by the single trajectory for site specific MSK diagnoses.

CONCLUSION: Prognostic subgrouping revealed more diverse patterns in pain and function recovery over 1 year than observed in the same patients classified by traditional diagnostic groups and may better reflect the diversity in recovery of common MSK disorders.

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