Psychosocial risk factor for poor outcome in low back pain

January 01, 0001

Psychosocial risk factor for poor outcome in low back pain

Low back pain is a common condition in primary care, and, especially with chronic pain, may have a significant psychosocial component. These French researchers performed a systematic review of prospective studies addressing psychosocial risk factors for poor outcome in patient with LBP using PuBmed, PsychInfo and Cochrane Library databases. The studies were reviewed methodologically by two independent reviews to determine if they met inclusion criteria.

The researchers found: "Twenty-three papers fulfilled the inclusion criteria, covering 18 different cohorts. Sixteen psychosocial factors were analysed in three domains: social and socio-occupational, psychological and cognitive and behavioural. Depression, psychological distress, passive coping strategies and fear-avoidance beliefs were sometimes found to be independently linked with poor outcome, whereas most social and socio-occupational factors were not. The predictive ability of a patient’s self-perceived general health at baseline was difficult to interpret because of biomedical confounding factors. The initial patient's or care provider's perceived risk of persistence of LBP was the factor that was most consistently linked with actual outcome."

The researchers concluded: "Few independent psychosocial risk factors have been demonstrated to exist. Randomized clinical trials aimed at modifying these factors have shown little impact on patient prognosis. Qualitative research might be valuable to explore further the field of LBP and to define new management strategies."

This systematic review finds little evidence of independent psychosocial risk factors for poor outcomes in low back pain

For the full abstract, click here.

Family Practice 28(1):12-21, February 2011
© the Authors 2010
Psychosocial risk factors for chronic low back pain in primary care—a systematic review. Aline Ramond, Céline Bouton, Isabelle Richard, et al. Correspondence to Aline Ramond:

Category: M. Musculoskeletal. Keywords: low back pain, psychosocial, depression, avoidance, prognosis, systematic review, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 5 March 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.