Entete 3

Psychosocial, musculoskeletal and somatoform comorbidity in patients with chronic low back pain in primary care

By Aline Ramond-Roquin

This recently published study (1) is part of my thesis in public health untitled “Risk factors, comorbidity and management of non-specific low back pain in general practice”, undertaken in the University of Angers, France, in partnership with the Department of Primary and Community Care of Nijmegen, The Netherlands.
Literature has suggested that patients with chronic low back pain (CLBP) presented higher level of psychosocial, musculoskeletal and somatoform comorbidity than general population. As such morbidity is particularly common in primary care, we were interested in the following question: in general practice, do patients presenting with CLBP more often present psychosocial, musculoskeletal and somatoform problems than patients presenting with other problems?
We extracted data from the Transition Project, a long-standing, experienced primary care practice-based network that has been systematically and prospectively coding the diagnoses related to all the encounters between the patients and their general practitioners, using the international classification of primary care. We compared the prevalence of the problems presented by 1511 patients with CLBP with those of their 1511 matched patients without CLBP, focusing on the period from one year before the beginning of an episode of care for CLBP to two years after it. Patients with CLBP presented higher prevalence of musculoskeletal problems but similar prevalence of psychosocial and non-musculoskeletal somatoform problems, compared to other patients consulting in the same setting. Therefore we concluded that:

1)    General practitioners should be aware of the frequency of multi-site musculoskeletal disorders, whether synchronous or metachronous, and adopt an integrated approach when caring for patients with such problems.
2)    Rather than  systematically screening for specific psychological, social or somatoform disorders, they should consider with the patient how CLBP and any type of potential comorbidity interfere with his/her daily functioning.

1) Ramond-Roquin A, Pecquenard F, Schers H, Van Weel C, Oskam S, Van Boven K. Psychosocial, musculoskeletal and somatoform comorbidity in patients with chronic low back pain: original results from the Dutch Transition Project. Fam Pract. 2015 Jun;32(3):297–304

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