A comparison of low back pain patients in the United States and New Zealand: Psychosocial and economic factors affecting severity of disability

Abstract

Patients suffering from chronic low back pain seen at the University of Virginia (USA) Pain Center (198) and similar patients seen at the Auckland Hospital, Auckland, New Zealand (NZ) Pain Clinic (117) completed a self-report questionnaire prior to beginning comparable outpatient treatment programs. Approximately 55% of the sample from each country returned a follow-up questionnaire 1 yr later. Despite nearly similar between-country reports of pain frequency and intensity, the USA patients both at pre- and post-testing reported greater emotional and behavioral disruption as a correlate of their pain. USA patients consistently used more medication, experienced more dysphoric mood states and were more hampered in social-sexual, recreational and vocational functioning. Patients from both countries demonstrated a nearly equal degree of pre- to post-improvement; the relative initial differences favoring the New Zealanders remained constant across both questionnaire administrations. At the onset of treatment, 49% of the USA sample and only 17% of the NZ patients were receiving pain-related financial compensation. At follow-up, patients from both countries receiving pretreatment compensation were less likely to report a return to full activity, although the relationship appeared more pronounced in USA patients. Seemingly, compared to the USA, the NZ compensation-disability system is used less, or for shorter durations of time, resulting in less severe life-style disruption than appears to be the case in the USA.