Two screening tools, the STarT Back Screening Tool and the Örebro Musculoskeletal Pain Questionnaire, may be useful in predicting the transition from subacute and acute to chronic low back pain, according to a systematic literature review published in Pain Medicine.

Predicting a transition to chronic low back pain with the use of reliable screening instruments is essential for optimal therapeutic targeting and management. Investigators conducted an integrative metareview of studies examining screening tools for chronic low back pain, searching MEDLINE/PubMed, PsychINFO, CINAHL, and Cochrane Database of Systematic Reviews for relevant articles. Only studies published after 2000 were included. From an initial total of 2274 candidate reports, 42 were selected for inclusion in the review and were categorized into 3 classes, depending on whether they involved screening instruments that assessed psychological, clinical, or functional metrics.

A total of 13 screening instruments were examined, 11 of which were deemed unable to offer sufficient evidence of predicting chronic low back pain trajectory. Two tools, the STarT Back Screening Tool and the Örebro Musculoskeletal Pain Questionnaire, were rated as valid, reliable, and capable of predicting which patients with acute or subacute low back pain were likely to have progression to chronic low back pain. These 2 instruments stratified patients into low-, medium- and high-risk categories. In addition to their predictive power, both tools have been translated into several languages and applied internationally and have further shown applicability in a variety of healthcare settings.

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Common predictors of low back pain chronicization were intense, widespread pain (particularly when increasing) and fear avoidance. The STarT Back Screening Tool and the Örebro Musculoskeletal Pain Questionnaire had better discrimination of bothersome/referred pain and pain intensity, respectively. The STarT Back Screening Tool, which was shorter, was easier to score and was considered an ideal screening tool for use in primary care settings.

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Study limitations include the possibility that other chronic low back pain screening tools were not accounted for in the review.

“Healthcare clinicians should consider integrating these instruments into routine care as a method of early treatment and/or referral to prevent a chronic pain trajectory,” noted the authors.


Pauli J, Starkweather A, Robins JL. Screening tools to predict the development of chronic low back pain: an integrative review of the literature [published online October 10, 2018]. Pain Med. doi:10.1093/pm/pny178

This article originally appeared on Clinical Pain Advisor