Determinants of chronic disability related to low back pain: Towards an integrative biopsychosocial model

Abstract

The proposed biopsychosocial model assumes that LBP-related chronic disability is possibly, in some cases, a stress-related disorder. Its empirical verification in LBP could particularly improve the understanding of the interrelationships between certain variables.

Attitudes and beliefs of Brazilian physical therapists about chronic low back pain: a cross-sectional study

“…Some prognostic factors may be able to explain these differences, such as past experiences of pain 2 , lower levels of education 2 , psychological factors 9 , and fear of persistence of pain 9 . Furthermore, preliminary evidence suggests that the attitudes and beliefs of patients about low back pain are associated with therapeutic outcomes 10,11 , levels of disability and quality of life 12 . For example, patients who believe that movement will lead to worsening pain have a higher risk for the persistence of symptoms and higher levels of disability [13][14][15] .…”

The benefits of theory for clinical practice: Cognitive treatment for chronic low back pain patients as an illustrative example

“…In this initial part of the diagnostic process biomedical theories are the most prevalent theories with regard to dysfunction. Physiological pathology is only found in 10 -20% of patients with low back pain [8,9]. Low back pain is referred to as nonspecific when there is no physiological cause that fully explains the back problem [10 -12].…”

“…Such cases, if they do not improve within 12 weeks, are referred to as chronic [9].With this change from acute to chronic, the low back problem is redefined, and consequently the range of hypotheses about the factors leading to the back problem is extended. The biomedical perspective on low back pain that guided the diagnostic process in the acute phase changes into a biopsychosocial perspective in the chronic phase [8,11,13]. Biomedical theories recede into the background, in favour of a vast field of psychosocial theories attempting to explain the persistence of the low back pain, such as treatments incorporating operant conditioning theories [14,15] and social cognitive theories [16 -20].…”

Psychosocial Risk Factors in the Development of LBP

“…Included in the domain of job and work environment include various aspects of job content, for example, perceived workload, monotonous work, low job control, low job satisfaction, limited social support (Truchon, 2001). Outside of work environment parameters typically include factors associated with demands and responsibilities in family situation and leisure time, and social/familial relationship and support.…”

“…Outside of work environment parameters typically include factors associated with demands and responsibilities in family situation and leisure time, and social/familial relationship and support. Finally, individual factors are generally of two types corresponding to: (1) sociodemographic factors, for example, age, social class, culture, educational status; life style (smoking) and (2) psychological factors, for example, affective variables (anxiety and depression), personality traits, cognitive variables (fear avoidance and life satisfaction) and coping strategies (catastrophizing) (Pincus et al, 2002a;Truchon, 2001).…”