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New model predicts whether low back pain is likely to become persistent

An Australian research team has developed a model to predict whether a person with acute back pain is likely to go on to develop persistent back pain (lasting for longer than three months).

A new study published in PLOS Medicine suggests that the five-item prognostic model, called PICKUP, has better predictive accuracy for pain outcomes than either clinician judgement or commonly used screening tools.

“Constructing accurate prognostic models is an essential step towards improving patient outcomes,” says lead researcher Dr James McAuley. “Twenty percent of adults suffer from back pain and almost all of them are worried about the pain becoming persistent. Back pain is the leading cause of early retirement and income poverty in older adults.

“An alternative to costly and ineffective management of back pain patients is to prevent them from experiencing persistent pain in the first place. Our model can help clinicians target, at a very early stage, the patients who might need a bit more help.”

Early, accurate prognostic information provides the opportunity for clinicians to advise their patients on whether or not further treatments are necessary. Offering tests and interventions to all patients is expensive, overburdens healthcare systems and diverts scarce resources from where they are most needed.

However, not treating high-risk patients may also be harmful, and a significant proportion may develop persistent back pain as a consequence. Tailoring the intensity of early intervention according to individual patient’s risk profile is the ideal approach.

The NeuRA research team developed their five-item screening questionnaire using study data from 1,230 patients with a recent episode of low back pain. They then tested how well the screening questionnaire could predict the onset of persistent pain in a separate sample of 1,528 patients in primary care.

They found that the screening questionnaire could predict the onset of persistent pain with an impressive level of accuracy.

The brief, easy-to-use online risk calculator has been made freely available to healthcare practitioners and researchers at Discussing these risk estimates with patients could reduce the number of unnecessary interventions provided to low-risk patients. “Communicating risk can be tricky – we are currently finishing an online app to help clinicians explain these risk estimates to a patient in a way that is reassuring and that helps them to recover,” says Dr McAuley.

How was the study conducted?

  • The five-item screening questionnaire, PICKUP, was developed using study data from 1,230 patients with a recent episode of low back pain.
  • Researchers tested PICKUP in a separate sample of 1,528 patients to see how well the model could predict the onset of persistent pain.
  • PICKUP could predict the onset of persistent pain with acceptable accuracy (area under the receiver operating characteristic curve = 0.66 [95% CI 0.63 to 0.69]; intercept = 0.55, slope = 0.89).


  • PICKUP is a new model used to determine the likelihood a person will develop persistent back pain
  • The five-item questionnaire has been developed and tested by NeuRA researchers
  • Its aim is to provide accurate prognostic information to patients, to prevent unnecessary tests and interventions, and to alleviate burden from healthcare systems
  • The PICKUP risk calculator is now available for clinicians and researchers to use

This study was published in the journal PLOS Medicine on Wednesday, May 18.