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Arthritis Care Res (Hoboken). 2019 Jan 14. doi: 10.1002/acr.23811. [Epub ahead of print]

The course of back pain in the Canadian population: trajectories, predictors, and outcomes.

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The Arthritis Program, Krembil Research Institute, University Health Network.
Arthritis Community Research and Evaluation Unit, Krembil Research Institute, University Health Network.



To identify and describe back pain (BP) trajectory groups and to compare indicators of health status, medication, and healthcare use by these groups.


A representative sample (n=12,782) of the Canadian population was followed-up from 1994 to 2011. Participants were interviewed bi-annually and provided data on socio-demographic (e.g. education), behavior-related (e.g. physical activity), depression, comorbidities, pain, disability, medication use (e.g. opioids) and healthcare use (e.g. primary care). We used group-based trajectory analysis to group participants based on the patterns of the course of BP over the 16-year follow-up. We compared indicators of pain, disability, medication and healthcare use by the BP trajectory groups.


45.6% of participants reported BP at least once during follow-up. Of those, we identified four trajectories: persistent (18.0%), developing (28.1%), recovery (20.5%), and occasional (33.4%). The persistent and developing groups were characterized by having more pain preventing activities, disability, depression, and comorbidities. There were significant differences in the patterns of medication and healthcare use across the groups, with a general trend of most to least healthcare and medication use in the persistent, developing, recovering, and occasional groups. Those in the 'recovery' group had an increasing trajectory of opioids and anti-depressants use.


Almost one-in-five people with BP experience a persistent trajectory with associated increased pain, disability, and healthcare use. Further research is needed to determine whether the identified groups represent different diagnoses, which may provide insights to the selection of stratified treatments and aid designing early prevention and management strategies in the population. This article is protected by copyright. All rights reserved.


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