{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T13:20:14Z","timestamp":1768569614315,"version":"3.49.0"},"posted":{"date-parts":[[2025,1,13]]},"group-title":"Pain Medicine","reference-count":23,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T00:00:00Z","timestamp":1736726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,1,13]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:p>Exacerbations of existing low back pain (LBP) or new LBP episodes are colloquially referred to as \u201cflares\u201d. Although the experience of flares is common to many people with LBP, few validated measures enable people to self-report if they are experiencing a flare. This study examined the convergent validity of a person-dependent definition of flares (\u201ca worsening of your low back pain that lasts from hours to weeks\u201d) as compared to (1) LBP intensity, (2) LBP-related pain interference, and (3) analgesic use, in a large, prospective research study of Veterans with LBP. Veterans seeking care for LBP (n=465) were followed prospectively for up to 1 year. Participants completed up to 36 scheduled surveys and additional patient-initiated surveys (triggered by the onset of new flares) over follow-up. Each survey inquired about current flare status, pain intensity measured on a 0 to 10 numeric rating scale (NRS), LBP-related pain interference, and analgesic use. Linear mixed-effects models estimated the association between current flare status and pain intensity, with and without adjustment for potential confounding factors; secondary analyses examined associations with pain interference and analgesic use. In longitudinal analyses of 11,817 surveys, flare status was significantly associated with a 2.8-NRS-point greater pain intensity (p&lt;0.0001), with and without adjustment for other factors. Statistically significant associations were found between flare status and LBP-related pain interference and analgesic use. New flare periods were associated with impacts on coping, functional limitations, and mood\/emotions. These findings support the convergent validity of a person-dependent flare definition.<\/jats:p>\n                <jats:sec>\n                  <jats:title>SUMMARY<\/jats:title>\n                  <jats:p>A person-dependent definition of \u201cflare\u201d among individuals with low back pain has convergent validity as shown by its associations with pain intensity and pain interference.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2025.01.11.25320390","type":"posted-content","created":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T17:40:13Z","timestamp":1736790013000},"source":"Crossref","is-referenced-by-count":0,"title":["Convergent validity of a person-dependent definition of a low back pain flare"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9449-4165","authenticated-orcid":false,"given":"Pradeep","family":"Suri","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Korpak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Timmons","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrienne D.","family":"Tanus","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah","family":"Brubeck","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathalia","family":"Costa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carina A.","family":"Staab","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Hodges","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clinton J.","family":"Daniels","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick J.","family":"Heagerty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark P.","family":"Jensen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2025011508051102000_2025.01.11.25320390v1.1","doi-asserted-by":"crossref","unstructured":"Costa N , Ferreira ML , Setchell J , Makovey J , Dekroo T , Downie A , Diwan A , Koes B , Natvig B , Vicenzino B , Hunter DJ , Roseen E , Rasmussen-Barr E , Guillemin F , Hartvigsen J , Bennel K , Costa L , Macedo L , Pinheiro M , Underwood M , Van Tulder M , Johansson M , Enthoven P , Kent P , O\u2019Sullivan P , Suri P , Genevay S, PW. H . A definition of \u2018flare\u2019 in low back pain (LBP): A multiphase process involving perspectives of individuals with LBP and expert consensus. J Pain 2019;Epub ahead of print.","DOI":"10.1016\/j.jpain.2019.03.009"},{"issue":"2","key":"2025011508051102000_2025.01.11.25320390v1.2","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.semarthrit.2018.01.012","article-title":"How is symptom flare defined in musculoskeletal conditions: A systematic review","volume":"48","year":"2018","journal-title":"Semin Arthritis Rheum"},{"issue":"9","key":"2025011508051102000_2025.01.11.25320390v1.3","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1097\/j.pain.0000000000002585","article-title":"Are objective measures of sleep and sedentary behaviours related to low back pain flares?","volume":"163","year":"2022","journal-title":"Pain"},{"issue":"5","key":"2025011508051102000_2025.01.11.25320390v1.4","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1097\/AJP.0000000000000926","article-title":"Low Back Pain Flares: How do They Differ From an Increase in Pain?","volume":"37","year":"2021","journal-title":"Clin J Pain"},{"key":"2025011508051102000_2025.01.11.25320390v1.5","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.2015.95.2.e1"},{"key":"2025011508051102000_2025.01.11.25320390v1.6","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.0734"},{"key":"2025011508051102000_2025.01.11.25320390v1.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32279-7"},{"key":"2025011508051102000_2025.01.11.25320390v1.8","unstructured":"Guzman G , Kollar M . 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