Pain location matters: the impact of leg pain on health care use, work disability and quality of life in patients with low back pain

In low back pain (LBP) patients, those with radiating leg pain or sciatica have worse pain and disability outcomes. Not many studies have assessed the effect of leg pain on health care use and quality of life. Prospective cohort study of 1,581 UK LBP primary care consultants. Back pain, employment, health care utilisation, and quality of life (EQ-5D) data were collected at baseline, 6 and 12 months. At baseline, patients were classified as reporting (1) LBP only, (2) LBP and leg pain above the knee only (LBP+AK) or (3) LBP and leg pain extending below the knee (LBP+BK). Self-reported leg pain was common; at baseline 645 (41%) reported LBP only, 392 (25%) reported LBP+AK and 544 (34%) reported LBP+BK. It was significantly more probable for patients with LBP+BK, compared to those with LBP only to be unemployed, take time off work, consult their family doctor, receive physical therapy, or be referred to other health care practitioners. There were statistically significant decrements in EQ-5D scores for LBP+AK compared to LBP only, and for LBP+BK compared to LBP+AK (p≤0.05 for all comparisons).

Patients with self-reported leg pain below the knee utilise more health care are more likely to be unemployed and have poorer quality of life than those with LBP only 12 months after primary care consultation. The presence of leg pain warrants early identification in primary care to investigate if targeted interventions can reduce the impact and consequences of leg pain.