The Global Spine Care Initiative: a narrative review of psychological and social issues in back pain in low- and middle-income communities

Abstract

Psychological and social factors are important components to addressing low back pain and health care providers play an important role in empowering patients to take control of their spinal health outcomes. Patients should be included in negotiating their spinal treatment and establishing treatment goals through careful listening, reassurance, and information providing by the health care provider. Instruments need to be developed for people with low literacy in medically underserved areas and low- and middle-income countries, especially where psychological and social factors may be difficult to detect and are poorly addressed. These slides can be retrieved under Electronic Supplementary Material.

The Global Spine Care Initiative: resources to implement a spine care program

“…This is consistent with the recommendations of others who have looked at the skills required to manage patients with nonspecific spine pain [32,33]. Necessary skills include the initial assessment of patients, triage for red flags suggestive of serious pathology, documentation of psychological or social flags and the management of patients with nonspecific pain and related disability (Class I and II) [11,18]. The latter would include patient and community education and noninvasive, low technology, lowcost interventions for symptom relief.…”

“…The GSCI articles on noninvasive care, public health and psychosocial interventions recommend an emphasis on selfcare and community-based care [11,13,18], which may be achieved through education to avoid misunderstanding of the prognosis and catastrophizing of spine pain. Education and prevention is a component of spine care that is often emphasized in guidelines but is difficult to put into practice.…”

“…The Global Spine Care Initiative (GSCI) has developed a model of spine care that is based on the GSCI classification system and care pathway, and foundational papers [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. The GSCI model of care has been developed so that it could be implemented in different settings with variable levels of health and community resources.…”

The Global Spine Care Initiative: care pathway for people with spine-related concerns

“…(2) non-invasive treatment; (3) invasive treatment; (4) psychological and social; (5) prevention and public health; and (6) specialty care and interdisciplinary/multidisciplinary management [24][25][26][27][28][29]. A review of the literature on compression fractures was included as a case study for spinal symptoms related to systemic pathology, in part because many patients with compression fractures can be managed in a primary spine care setting.…”

The Global Spine Care Initiative: classification system for spine-related concerns

“…Clinicians in general practice see people with minor symptoms or concerns who either may seek advice for prevention or may be seeking care for another complaint. It was recommended that any model of care should include guidance on current evidence as defined in the GSCI papers concerning prevention including risk factors, comorbidities, and the importance of psychosocial concerns that could lead to over-medicalization [24][25][26][27][28][29][30]. Primary and secondary prevention measures, whether applied at a population or individual level, could potentially reduce further the burden of spine disorders when applied to the specific needs of any given community [28,30].…”