Screening of Psychosocial Risk Factors (Yellow Flags) for Chronic Back Pain and Disability

Main, Chris J.; Kendall, Nicholas A.S.; Hasenbring, Monika

doi:10.1093/med/9780199558902.003.0060

Cited by 11 publications

(30 citation statements)

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“…Also impressive is how health care providers and patients alike reported similar causes of chronicity and emphasize the influence of iatrogenic factors that are rarely discussed in the scientific community. Furthermore, the patients emphasized the balance between effort and reward at the workplace, and to a lesser extent, distress at the workplace, as it is described in other flag catalogs 9,47. Health care providers additionally underlined the importance of a good social environment and support.…”

Section: Discussionmentioning

confidence: 81%

“…Approximately half of them experienced around 10 critical LEs, with 60% of these reported to have occurred in the last 5 years. Neither effort-reward imbalances nor critical life events are cited as important risk factors within the flag catalog 9,47. The high frequency of critical LEs preceding the onset of back pain in our main study confirms theoretical links between a high allostatic load and pain syndromes and an accumulation related to biography 24.…”

Section: Discussionmentioning

confidence: 99%

“…Although the frequent use of prescribed pain medications in combination can become undetected medication abuse, a topic that should receive more attention, it is important to note that sociodemographic and lifestyle factors have a huge influence on the medical history of patients 14. Research is beginning to uncover that declared orange flag factors (e.g., substance abuse, gender) are of greater importance than suggested in the current flag catalog and should be respected by health care providers 9,48. Interestingly though, physical activity and alcohol abuse held weaker influence than previously hypothesized.…”

Section: Discussionmentioning

confidence: 99%

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Risk and protective factors in the clinical rehabilitation of chronic back pain

Wippert¹,

Fliesser²,

Krause³

2017

JPR

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ObjectivesChronic back pain (CBP) can lead to disability and burden. In addition to its medical causes, its development is influenced by psychosocial risk factors, the so-called flag factors, which are categorized and integrated into many treatment guidelines. Currently, most studies investigate single flag factors, which limit the estimation of individual factor significance in the development of chronic pain. Furthermore, factors concerning patients’ lifestyle, biography and treatment history are often neglected. Therefore, the objectives of the present study are to identify commonly neglected factors of CBP and integrate them into an analysis model comparing their significance with established flag factors.MethodsA total of 24 patients and therapists were cross-sectionally interviewed to identify commonly neglected factors of CBP. Subsequently, the impact of these factors was surveyed in a longitudinal study. In two rehabilitation clinics, CBP patients (n = 145) were examined before and 6 months after a 3-week inpatient rehabilitation. Outcome variables, chronification factor pain experience (CF-PE) and chronification factor disability (CF-D), were ascertained with confirmatory factor analysis (CFA) of standardized questionnaires. Predictors were evaluated using stepwise calculations of simple and multiple regression models.ResultsThrough interviews, medical history, iatrogenic factors, poor compliance, critical life events (LEs), social support (SS) type and effort–reward were identified as commonly neglected factors. However, only the final three held significance in comparison to established factors such as depression and pain-related cognitions. Longitudinally, lifestyle factors found to influence future pain were initial pain, physically demanding work, nicotine consumption, gender and rehabilitation clinic. LEs were unexpectedly found to be a strong predictor of future pain, as were the protective factors, reward at work and perceived SS.DiscussionThese findings shed insight regarding often overlooked factors in the development of CBP, suggesting that more detailed operationalization and superordinate frameworks would be beneficial to further research.ConclusionIn particular, LEs should be taken into account in future research. Protective factors should be integrated in therapeutic settings.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Risk and protective factors in the clinical rehabilitation of chronic back pain

Wippert¹,

Fliesser²,

Krause³

2017

JPR

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“…Two previous studies testing the effect of information-based interventions also reported positive effects on self-reported severity of symptoms [26, 59], whereas Cherkin et al (1996) did not find effect of a similar intervention on perceived symptom reliefs [60]. Since these studies delivered somewhat different messages in different ways, perhaps the effect on pain depends partly on the nature, style and consistency of the messages, a feature that has been considered previously to be important [61]. …”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, in recent qualitative studies, workers themselves have suggested that such things as having adjustment latitude/leeway at the workplace improves their possibilities for coping with LBP at work [70, 71] while low ‘job control’ has been suggested as a predictor for poor occupational outcomes such as return-to-work [72]. Some of these issues are discussed in detail elsewhere [61], but for the present discussion it is, perhaps, sufficient to say that there is seemingly good reason to combine population and individual biopsychosocial educational approaches if work participation behaviors are the target outcomes.…”

Section: Discussionmentioning

confidence: 99%

Can group-based reassuring information alter low back pain behavior? A cluster-randomized controlled trial

et al. 2017

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BackgroundLow back pain (LBP) is common in the population and multifactorial in nature, often involving negative consequences. Reassuring information to improve coping is recommended for reducing the negative consequences of LBP. Adding a simple non-threatening explanation for the pain (temporary muscular dysfunction) has been successful at altering beliefs and behavior when delivered with other intervention elements. This study investigates the isolated effect of this specific information on future occupational behavior outcomes when delivered to the workforce.DesignA cluster-randomized controlled trial.MethodsPublically employed workers (n = 505) from 11 Danish municipality centers were randomized at center-level (cluster) to either intervention (two 1-hour group-based talks at the workplace) or control. The talks provided reassuring information together with a simple non-threatening explanation for LBP—the ‘functional-disturbance’-model. Data collections took place monthly over a 1-year period using text message tracking (SMS). Primary outcomes were self-reported days of cutting down usual activities and work participation. Secondary outcomes were self-reported back beliefs, work ability, number of healthcare visits, bothersomeness, restricted activity, use of pain medication, and sadness/depression.ResultsThere was no between-group difference in the development of LBP during follow-up. Cumulative logistic regression analyses showed no between-group difference on days of cutting down activities, but increased odds for more days of work participation in the intervention group (OR = 1.83 95% CI: 1.08–3.12). Furthermore, the intervention group was more likely to report: higher work ability, reduced visits to healthcare professionals, lower bothersomeness, lower levels of sadness/depression, and positive back beliefs.ConclusionReassuring information involving a simple non-threatening explanation for LBP significantly increased the odds for days of work participation and higher work ability among workers who went on to experience LBP during the 12-month follow-up. Our results confirm the potential for public-health education for LBP, and add to the discussion of simple versus multidisciplinary interventions.

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Biopsychosoziale Krankheitsmodelle

Hasenbring

2016

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Screening of Psychosocial Risk Factors (Yellow Flags) for Chronic Back Pain and Disability

Cited by 11 publications

References 0 publications

Risk and protective factors in the clinical rehabilitation of chronic back pain

Risk and protective factors in the clinical rehabilitation of chronic back pain

Can group-based reassuring information alter low back pain behavior? A cluster-randomized controlled trial

Biopsychosoziale Krankheitsmodelle

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