Back pain worse when accompanied by anterior trunk pain

By Will Boggs MD

NEW YORK (Reuters Health) - Patients with anterior trunk pain tend to have worse pain and disability from their chronic low back pain, according to a database study.

"Our study found that just under 20% of patients complaining of chronic low back pain also described pain in their front regions," John Panagopoulos from Macquarie University, New South Wales, Australia told Reuters Health. "This is a phenomenon that I have seen clinically in my own physiotherapy practice, but one could say I was surprised by how high this number was."

Several studies have reported poorer outcomes for people who have low back pain and widespread body pain, but no studies have investigated the independent role of anterior trunk pain as a contributor to low back pain and associated disability.

Panagopoulos and colleagues used data from Southern Denmark's SpineData database to evaluate the prevalence of anterior trunk pain in patients presenting with chronic low back pain and to ascertain whether it influenced the presentation or course of low back pain.

Among the 2974 participants, 583 (19.6%) reported anterior trunk pain (149 with chest pain and 501 with abdominal/groin pain), according to the authors.

As reported online February 5th in Pain, patients with anterior trunk pain had greater depression, worse general health, and higher proportions of widespread body pain, compared with patients not reporting anterior body pain.

Patients with anterior trunk pain reported low back pain intensity about 0.5 higher (on a scale of 0 to 10) than did patients without anterior trunk pain, but anterior trunk pain did not predict pain intensity in the multivariable model.

Similarly, patients with anterior trunk pain reported disability 6 points higher (on a scale of 0 to 100) at all time points, compared with patients not reporting anterior trunk pain, and this difference persisted after multivariable adjustment.

These differences were small and of uncertain clinical importance, the researchers say.

In contrast, anterior trunk pain did not predict the clinical course of low back pain or disability in univariate and multivariable models.

"Given this study was not designed to explain mechanisms for how anterior trunk pain may have occurred, we were cautious to not speculate," Panagopoulos said. "However, known visceral referred pain pathways have been shown in experimental studies. In contrast, we know that the low back area can refer pain to the front of the body as well. At this early stage of research, it is difficult to know which is more likely to be happening in chronic low back patients, but it will be interesting to find out."

"Research into low back pain continues to demonstrate that low back pain seems to have various causative factors, and each factor appears to be responsible for only a small proportion of total low back pain presentations," Panagopoulos said. "I would like physicians to take away from this report that anterior trunk pain is another factor that can cause or exacerbate low back pain."

"Given this is a very early stage of this research and that this study doesn't tell us much about management, I would suggest that these patients with anterior trunk pain symptoms should be managed the same as other low back pain patients," Panagopoulos concluded.

SOURCE: http://bit.ly/1aW1ofD

Pain 2014.

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