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Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. 2006 May 1; 56(526): 334–341.
PMCID: PMC1837841

Predicting persistent disabling low back pain in general practice: a prospective cohort study

Gareth T Jones, PhD, Senior Lecturer in Epidemiology
Epidemiology Group, Department of Public Health, University of Aberdeen, Aberdeen
Ruth E Johnson, PhD, MIDAS Trial Manager
Division of Clinical Psychology, University of Manchester, Manchester
Nicola J Wiles, PhD, Lecturer in Epidemiology
Academic Unit of Psychiatry, Department of Community Based Medicine, University of Bristol
Carol Chaddock, Grad Dip Phys, MCSP, SRP, Clinical Specialist Physiotherapist and Richard G Potter, MRCGP, Lead Clinician
Eastern Cheshire Chronic Pain Management Service, Eastern Cheshire Primary Care Trust, Macclesfield
Chris Roberts, PhD, Senior Lecturer in Medical Statistics
Biostatistics Group, University of Manchester, Manchester
Deborah PM Symmons, MD, MFPH, FRCP, Professor of Rheumatology and Musculoskeletal Epidemiology, and Honorary Consultant Rheumatologist
Arthritis Research Campaign Epidemiology Unit, University of Manchester and East Cheshire NHS Trust
Gary J Macfarlane, PhD, MD, Professor of Epidemiology



Patients may adopt active and/or passive coping strategies in response to pain. However, it is not known whether these strategies may also precede the onset of chronic symptoms and, if so, whether they are independent predictors of prognosis.


To examine, in patients with low back pain in general practice, the prognostic value of active and passive coping styles, in the context of baseline levels of pain, disability and pain duration.

Design of study

Prospective cohort study.


Nine general practices in north west England.


Patients consulting their GP with a new episode of low back pain were recruited to the study. Information on coping styles, pain severity, disability, duration, and a brief history of other chronic pain symptoms was recorded using a self-completion postal questionnaire. Participants were then sent a follow-up questionnaire, 3 months after their initial consultation, to assess the occurrence of low back pain. The primary outcome was persistent disabling low back pain, that is, low back pain at 3-month follow-up self-rated as ≥20 mm on a 100 mm visual analogue scale, and ≥5 on the Roland and Morris Disability Questionnaire.


A total of 974 patients took part in the baseline survey, of whom 922 (95%) completed a follow-up questionnaire; 363 individuals (39%) reported persistent disabling pain at follow-up. Persons who reported high levels of passive coping experienced a threefold increase in the risk of persistent disabling low back pain (relative risk [RR] = 3.0; 95% confidence interval [CI] = 2.3 to 4.0). In contrast, active coping was associated with neither an increase nor a decrease in the risk of a poor prognosis. After adjusting for baseline pain severity, disability, and other measures of pain and pain history, persons who reported a high passive coping score were still at 50% increased risk of a poor outcome (RR = 1.5; 95% CI = 1.1 to 2.0).


Patients who report passive coping strategies experience a significant increase in the risk of persistent symptoms. Further, this risk persists after controlling for initial pain severity and disability. The identification of this low back pain subgroup may help target future treatments to those at greatest risk of a poor outcome.

Keywords: coping behavior, general practice, low back pain, prognosis

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners