Psychosocial risk factors for chronic low back pain in primary care--a systematic review

Ramond, A.; Bouton, Céline; Rodet-Belarbi, Isabelle; Roquelaure, Yves; Baufreton, Christophe; Legrand, Érick; Huez, Jean Francxois

doi:10.1093/fampra/cmq072

Cited by 321 publications

(222 citation statements)

References 74 publications

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“…10 Avoidance of activities because of fear of pain or injury is an approach to protecting the back that negatively influences outcome. 9 Our findings show that clinicians can contribute to avoidance beliefs directly by focusing upon what patients should not do and indirectly by providing management advice and pathoanatomic explanations, which are interpreted as meaning the spine is vulnerable and requires protection. Nearly all participants reported receiving pathoanatomic explanations for the cause of their back pain, despite guideline recommendations against doing so.…”

Section: Discussionmentioning

confidence: 75%

“…7,8 Depression, passive coping strategies, fear avoidance beliefs (the avoidance of movement or activity resulting from fear of pain or injury), and low expectations of recovery are independently associated with poor outcome. 9,10 A clinical guide to assessing psychosocial warning signs (yellow flags) developed in New Zealand has been adopted internationally. 11 Patients' beliefs need to be better understood to improve management of low back pain.…”

Section: Introductionmentioning

confidence: 99%

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The Enduring Impact of What Clinicians Say to People With Low Back Pain

Darlow

Dowell

Baxter

et al. 2013

The Annals of Family Medicine

222

154

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PURPOSE The purpose of this study was to explore the formation and impact of attitudes and beliefs among people experiencing acute and chronic low back pain.METHODS Semistructured qualitative interviews were conducted with 12 participants with acute low back pain (less than 6 weeks' duration) and 11 participants with chronic low back pain (more than 3 months' duration) from 1 geographical region within New Zealand. Data were analyzed using an Interpretive Description framework.RESULTS Participants' underlying beliefs about low back pain were influenced by a range of sources. Participants experiencing acute low back pain faced considerable uncertainty and consequently sought more information and understanding. Although participants searched the Internet and looked to family and friends, health care professionals had the strongest influence upon their attitudes and beliefs. Clinicians influenced their patients' understanding of the source and meaning of symptoms, as well as their prognostic expectations. Such information and advice could continue to influence the beliefs of patients for many years. Many messages from clinicians were interpreted as meaning the back needed to be protected. These messages could result in increased vigilance, worry, guilt when adherence was inadequate, or frustration when protection strategies failed. Clinicians could also provide reassurance, which increased confidence, and advice, which positively influenced the approach to movement and activity.CONCLUSIONS Health care professionals have a considerable and enduring influence upon the attitudes and beliefs of people with low back pain. It is important that this opportunity is used to positively influence attitudes and beliefs. INTRODUCTIONL ow back pain is a health condition with major direct and indirect costs.1-4 Acute low back pain is assumed to have a highly positive prognosis 5 ; however, a large proportion of patients continue to experience pain and disability. 6 Psychosocial factors are important in the development of low back pain and disability. 7,8 Depression, passive coping strategies, fear avoidance beliefs (the avoidance of movement or activity resulting from fear of pain or injury), and low expectations of recovery are independently associated with poor outcome.9,10 A clinical guide to assessing psychosocial warning signs (yellow flags) developed in New Zealand has been adopted internationally. Patients' beliefs need to be better understood to improve management of low back pain. 10,12,13 People with low back pain receive information from a range of sources, but the influence of each source is unknown.14,15 Studies have investigated activities, situations, and anatomic structures that people see as being responsible for their back pain, but not how or why beliefs have been formed. 14,[16][17][18] Health care professionals may negatively influence patient beliefs. 19There is strong evidence that patients' beliefs about low back pain are associated with their clinicians' beliefs, and moderate evidence suggests

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Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

The Enduring Impact of What Clinicians Say to People With Low Back Pain

Darlow

Dowell

Baxter

et al. 2013

The Annals of Family Medicine

222

154

View full text Add to dashboard Cite

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“…Some studies have found depression to be associated with an increased risk of developing LBP (6)(7)(8), while other studies have failed to show a significant association (9)(10)(11). Previous reviews investigating the role of psychological variables in LBP have shown evidence of depression as a predictor of poor outcomes, such as chronicity, disability, and work absenteeism (12)(13)(14). However, these reviews did not specifically focus on premorbid depression as a risk factor for new cases of LBP.…”

Section: Introductionmentioning

confidence: 99%

Symptoms of Depression and Risk of New Episodes of Low Back Pain: A Systematic Review and Meta‐Analysis

Pinheiro

Ferreira

Refshauge

et al. 2015

Arthritis Care & Research

150

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Objective. To investigate the contribution of symptoms of depression to future episodes of low back pain (LBP). Methods. A search was conducted of AMED, CINAHL, Embase, Health and Society (H&S), LILACS, MEDLINE, PsycINFO, Scopus, and Web of Science databases. We included cohort studies investigating the effect of symptoms of depression on the development of new episodes of LBP, either lifetime incidence or a recurrent episode, in a population free of LBP at baseline. We accepted the original study's definition for a new episode of LBP, and for classifying patients as LBP-free at study entry. Two independent investigators extracted data and assessed methodological quality. Meta-analyses with random effects were used to pool risk estimates. Results. We included 19 studies, with 11 incorporated in the meta-analyses. Overall pooled results showed that symptoms of depression increased the risk of developing LBP (odds ratio [OR] 1.59, 95% confidence interval [95% CI] 1.26-2.01). The risk was similar in studies that used the diagnostic interview method (OR 1.66, 95% CI 1.14-2.42) and in studies using selfreport screening questionnaires (OR 1.68, 95% CI 1.05-2.70). No statistically significant relationship was observed when we pooled studies that employed nonspecific screening questionnaires (OR 1.17, 95% CI 0.48-2.87). Three studies provided results in incremental categories of symptoms of depression and the pooled OR for the most severe level of depression (OR 2.51, 95% CI 1.58-3.99) was higher than for the lowest level (OR 1.51, 95% CI 0.89-2.56). Conclusion. Individuals with symptoms of depression have an increased risk of developing an episode of LBP in the future, with the risk being higher in patients with more severe levels of depression.

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“…These factors can be aggregated into a smaller number of categories [9] including biomechanical factors (regular lifting, exposure to vibration, physically demanding jobs, bending and twisting, pushing and pulling heavy loads, awkward posture) [2,[7][8][9][10][11][12][13][14][15][16][17][18][19][20], psychological/psychosocial factors (job satisfaction, local support in the workplace, depression, job control, stress) [2,7,9,16,[19][20][21][22][23][24][25] and individual risk factors (sedentary lifestyle, age, smoking, gender, obesity, poor general health, marital status, pregnancy) [2,7,9,12,13,20,21,23,[26][27][28][29][30][31]. Past studies have investigated many of these factors and their relationship to LBP.…”

Section: Introductionmentioning

confidence: 99%

Clinicians’ views on factors that trigger a sudden onset of low back pain

et al. 2013

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Purpose Little is known about what triggers an episode of low back pain (LBP) in those presenting to primary care. Previous studies of risk factors have focused on specific occupational settings and work conditions. No study has asked primary care clinicians to consider what triggers an episode of sudden-onset LBP in patients presenting to them for care. The purpose of this study, therefore, was to describe the short-and long-term factors that primary care clinicians consider important in triggering a sudden episode of acute LBP. Methods One hundred and thirty-one primary care clinicians who were recruiting patients with LBP to a large observational study were invited to participate. A questionnaire was designed to obtain information about the clinician's characteristics, profession and clinical experience. We also asked clinicians to nominate the five shortand five long-term exposure factors, most likely to trigger a sudden episode of acute LBP, based on their experience. Descriptive statistics and frequency distributions were used to describe clinician's characteristics and the frequencies of the main risk factor categories were reported. Results Based on the views of 103 primary care clinicians, biomechanical risk factors appear to be the most important short-term triggers (endorsed by 89.3 % of clinicians) and long-term triggers (endorsed by 54.2 % of clinicians) for a sudden episode of acute LBP. Individual risk factors were endorsed by 39 % of clinicians as important long-term triggers, while only 6.4 % of clinicians considered them important short-term triggers. Other risk factors, such as psychological/psychosocial and genetic factors, were not commonly endorsed as risk factors for an episode of LBP by primary care clinicians. Conclusions This study shows that primary care clinicians believe that biomechanical risk factors are the most important short-term triggers, while biomechanical and individual risk factors are the most important long-term triggers for a sudden onset of LBP. However, other risk factors, such as psychological/psychosocial and genetic, were not commonly endorsed as risk factors for an episode of LBP by primary care clinicians. Results of this study are based on primary care clinicians' views and further investigation is needed to test the validity of these suggested risk factors.

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Psychosocial risk factors for chronic low back pain in primary care--a systematic review

Cited by 321 publications

References 74 publications

The Enduring Impact of What Clinicians Say to People With Low Back Pain

The Enduring Impact of What Clinicians Say to People With Low Back Pain

Symptoms of Depression and Risk of New Episodes of Low Back Pain: A Systematic Review and Meta‐Analysis

Clinicians’ views on factors that trigger a sudden onset of low back pain

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