Research to be presented today to the combined Australia and New Zealand Orthopaedic Associations' scientific meeting in Rotorua by orthopaedic surgeon and rheumatologist Dr Markus Melloh suggests people's attitudes to their non-specific, lower-back pain can be used to predict whether their pain will progress from an acute to a persistent condition.
Dr Melloh, the spine research programme director at the University of Otago's Centre for Musculoskeletal Outcomes Research, said most people experienced non-specific lower-back pain at least once in their lives.
In about 95% of cases the condition corrected itself, but a minority went on to develop persistent lower-back pain which had significant socioeconomic and personal costs.
In the study, patients presenting with their first episode of acute lower-back pain were interviewed at that time and then followed up at three, six and 12 weeks, and then at six months. This included an assessment of their attitude to their condition.
Dr Melloh said these patients were not those exhibiting signs of conditions such as slipped discs which would need referral to a specialist, but those who had non-specific pain.
While the study began with 315 patients, only 169 of these participated over the whole time of the study.
By six months, about a third of these, 64 patients, were classed as having a persistent condition.
Researchers found those who continued to show what is called "maladaptive cognitions" - fear and helplessness about their condition, movement avoidance and magnification of its seriousness - were the most likely to develop a persistent condition.
Some of these patients reported worse pain after six months which was not what would usually be expected, Dr Melloh said.
The researchers found, however, that the best time to screen patients about their thinking was not at the time of the first consultation with the doctor.
Three weeks after the onset of the pain, their attitude could influence the likelihood of developing a persistent condition.
The longer the "maladaptive cognitions" about the pain went on, the more likely the patient was to have a long-term condition.
The study suggested therapies to address the way patients were thinking about their condition should be considered as early extra treatment for lower-back pain for those patients who appeared to be at risk of developing a persistent condition.
Dr Melloh said general practitioners had an important role to play in this, although the "tricky thing" was that they had a heavy workload.
