Biobehavioral Factors Affecting Pain and Disability in Low Back Pain: Mechanisms and Assessment

Abstract

Patients with recurrent or persistent low back pain (LBP) and disability represent a formidable challenge to physical therapists. Classic models of disease and pain mechanisms do not adequately explain the commonly observed discrepancies between the extent of pathology and reported pain, or the level of pain and disability. Research over the past decade that considers the interactive role of biological, environmental, and psychological processes in pain and disability has supported the involvement of a number of biobehavioral factors in these conditions. Physical therapists and other health care providers have become more aware of these factors and their impact on the evaluation, treatment, and management of LBP. Despite this recognition, little information is available that translates the implications of this research to direct care within physical therapy practice. The purposes of this article are (1) to provide an operational definition of biobehavioral factors; (2) to review the role of these factors in the clinical presentation of LBP, functional limitation, and disability; (3) to identify commonly used approaches for their recognition and quantification; (4) to illustrate how an understanding of biobehavioral factors can assist the physical therapist in evaluation and treatment of patients with LBP; and (5) to identify certain gaps in current knowledge of the role of biobehavioral factors and their application in physical therapy. Given the central role assumed by many physical therapists in the management of LBP, acknowledging and addressing these factors in clinical practice should assist in the prevention of chronic LBP and disability, as well as potentially improve physical therapy interventions and management.

Current Understanding of Lumbar Intervertebral Disc Degeneration: A Review With Emphasis Upon Etiology, Pathophysiology, and Lumbar Magnetic Resonance Imaging Findings

“…38,92,118 Many patients may interpret this label as "deteriorating disc disease," and wrongfully believe that their spines are becoming weaker, leading to a life of severe, debilitating pain. This erroneous belief may be reinforced by some healthcare practitioners who try to motivate patients to undergo expensive and/ or long-term courses of treatment.…”

“…Elevated fear-avoidance beliefs, disease conviction, and other adverse biobehavioral factors can potentially result. 38 Considering this, it is important that clinicians carefully communicate with patients to reassure them that DD is a normal aging process; while it certainly can be associated with episodes of pain, only in rare exceptions do these symptoms represent serious disease, and they should not, therefore, prevent one from performing reasonable activities.…”

The Relationship of Anticipated Pain and Fear Avoidance Beliefs to Outcome in Patients With Chronic Low Back Pain Who Are Not Receiving Workers’ Compensation

“…[1][2][3][4][5] When compared to individuals without symptoms, patients with chronic LBP have had reductions in the crosssectional area and force generating capacity of lumbar muscles, 6 -8 slower walking speed, 2 and less lumbar range of motion. 9,10 However, recent literature has suggested that in many instances, biobehavioral factors explain a larger portion of the variance in a patient's clinical picture than do measures of physical impairment.…”

Guide to Outcomes Measurement for Patients With Low Back Rain Syndromes

“…The measurement of the patient's return to work as an outcome of health care, however, has numerous limitations, which suggests that return to work may not be a valid indicator of improvement in patients with low back pain. 25,35 Because improvement of function and quality of life is not necessarily related to work status, use of return to work as an indicator of treatment success is problematic. There are many instances of patients who have made improvement but are not working for various reasons.…”