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Objectives The study objectives were to identify baseline predictors of low back pain severity changes over a one-year period among patients attending multidisciplinary tertiary clinics and determine whether health care utilization impacts this outcome. Methods This is a retrospective cohort study using the Quebec Pain Registry (QPR). A total of 686 low back pain (LBP) patients (55.8% females, mean age = 56.51 ± 14.5 years) from the QPR were selected for this study. Patients completed self-report questionnaires and nurse-administered questionnaires before their first appointment at a multidisciplinary pain treatment center. Analysis was conducted using a linear growth model. Results There was a modest (10%) improvement in pain severity scores over a 12-month period. Pain catastrophizing and depressive symptoms predicted higher baseline levels of pain severity (P  < 0.001). Having used self-management approaches over the past six months was associated with higher levels of pain severity at 12 months (P  < 0.001). Discussion Results from this study showed no clear pattern of association between the use of different treatment disciplines and pain severiy over the first year after multidisciplinary treatment intervention. These results raise an important question as to the best way of utilizing scarce multidisciplinary resources to optimize cost-effectiveness and improve outcomes among complex, chronic LBP patients. [ABSTRACT FROM AUTHOR]