Harland, N., & Lavallee, D. (2003). Biopsychosocial management of chronic low back pain patients with psychological assessment and management tools. Physiotherapy, 89, 305-312.
AbstractThe volume of evidence questioning the efficacy of traditional treatment methods for chronic low back pain sufferers is only equalled by that condoning a holistic, biopsychosocial assessment and treatment approach. Literature on this subject is often academic in nature and does little to offer practical advise to clinicians on how they can apply psychosocial principles to practice. This paper addresses the reasons behind the increasing number of chronic back pain patients, reviews the relevant psychological models that aid understanding of this client group, and offers basic practical advise on psychosocial assessment and treatment methods that can be applied by both specialist and non-specialist physiotherapists.
Biopsychosocial management of chronic low back pain patients with psychological assessment and management toolsPhysiotherapists play an important role in the management of chronic low back pain (CLBP) patients. Successful management of this client group poses a significant problem, however. Recent advances in this research area, specifically regarding psychological factors, have generated various principles and assessment techniques whose application can add to clinical effectiveness. There are also a number of existing psychological principles, not commonly referred to in the literature, that are important to understand when treating patients in chronic pain. The purpose of this paper is to review these principles and highlight the importance of their application into the practice of physiotherapy.The prevalence of people consulting medical practitioners with CLBP has increased so dramatically in recent years that it has been referred to as a "20 th century health care disaster" (Waddell, 1998). Only headaches and tiredness are more commonly reported to GPs than back pain (CSAG, 1994), with 60% of the population suffering from some form of back pain each year (Evans, 1996; Foster, 1998; McKinnon, 1997). People have always had back pain, however, and its prevalence is not thought to have changed for decades (CSAG, 1994), it is only the prevalence of people seeking medical attention for it that has changed. This has highlighted the fact that CLBP is one of the least successfully treated musculoskeletal conditions. A growing body of evidence shows that the majority of treatments for CLBP lack quality validating research and are, therefore, not evidence based (CSAG, 1994; Evans, 1996; Clinical Evidence, 2001). It is also thought in some fields, that medical intervention is perhaps part of the reason for the drastic rise in disability secondary to CLBP (Gifford, 1998; Waddell, 1998).This phenomenon has been partly attributed to the adoption of a unimodal medical model of low back pain in the post-war years, that allowed itself to be more guru, than scientifically led (Gifford, 1998). Prior to the adoption of the medical ...
