Even when acute, lower back pain usually resolves within a month. But some patients with lower back pain can develop chronic back pain, which can be quite debilitating. Chou and Shekelle conducted a literature review to determine if individual risk factors or risk prediction instruments could predict which patients with lower back pain would develop chronic pain.

The review included 20 English-language studies with a total of 10,842 adults who experienced lower back pain for less than eight weeks. Of the 20 studies, 14 looked at individual risk factors and 10 examined risk prediction instruments, with four studies evaluating both.

The analysis showed that individual risk factors were only weak predictors of persistent pain. Those that were the best predictors of worse outcomes at one year were nonorganic signs (the pain had a psychological component or was intentionally exaggerated), high maladaptive pain coping behaviors, high baseline functional impairment, psychiatric comorbidities, and low overall health status. Recovery at one year was best predicted by low fear avoidance and low baseline functional impairment. Baseline pain, radiculopathy, and work-related variables were poorly predictive, while demographics (such as age and weight) and lower back pain history didn't correlate with chronic pain.

While no risk prediction instruments have been extensively validated, they may be more helpful in predicting chronic pain than individual risk factors. The authors recommended further research into the use of these instruments.