Abstract
Purpose
The purpose of this review was to describe psychological and social factors associated with low back pain that could be applied in spine care programs in medically underserved areas and low- and middle-income countries.
Methods
We performed a narrative review of cohort, cross-sectional, qualitative and mixed methods studies investigating adults with low back pain using Medline and PubMed were searched from January 2000 to June 2015. Eligible studies had at least one of the following outcomes: psychological, social, psychosocial, or cultural/ethnicity factors. Studies met the following criteria: (1) English language, (2) published in peer-reviewed journal, (3) adults with spinal disorders, (4) included treatment, symptom management or prevention.
Results
Out of 58 studies, 29 were included in this review. There are few studies that have evaluated psychological and social factors associated with back pain in low- and middle-income communities, therefore, adapting recommendations from other regions may be needed until further studies can be achieved.
Conclusion
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.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
Similar content being viewed by others
References
Meyer TG, Mooney Gatchel RJ (eds) (1991) Contemporary conservative care for painful spinal disorders. Lea and Febiger, Malvern
Wiesel SW, Weinstein JN, Herkowitz H, Dvorak J, Bell G (eds) (1996) The lumbar spine, 2nd edn. WB Saunders, Philadelphia
Frymoyer JW (ed) (1997) The adult spine. Principles and practice, vol 2. Lippincott-Raven, Philadelphia
Schellhas KP, Pollei SR, Gundry CR, Heithoff KB (1996) Lumbar disc high-intensity zone: correlation of magnetic resonance imaging and discography. Spine 21:79–86
Linsiński P (2000) Surface EMG in chronic low back pain. Eur Spine J 9:559–562
Haldeman S, Shouka M, Robboy S (1988) Computed tomography, electrodiagnostic and clinical findings in chronic workers’ compensation patients with back and leg pain. Spine 13:345–350
Carragee EJ, Paragioudakis SJ, Khurana S (2000) 2000 Volvo award winner in clinical studies: lumbar high-intensity zone and discography in subjects without low back problems. Spine 25:2987–2992
Bigos S (1999) Perils, pitfalls, and accomplishments of guidelines for treatment of back problems. Neurol Clin 17:179–192
Lumley MA, Cohen JL, Borszcz GS, Cano A et al (2011) Pain and emotion: a biopsychosocial review of recent research. J Clin Psychol 67:942–968
Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC (2007) The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull 133:581–624
Nicholas MK, George SZ (2011) Psychologically informed interventions for low back pain: an update for physical therapists. Phys Ther 91:765–776. https://doi.org/10.2522/ptj.20100278
Waddell G (1987) Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain. Spine 12(7):632–644
Kendall NAS, Linton SJ, Main CJ (1997) Guide to assessing psychosocial yellow flags in acute low back pain: risk factors for long-term disability and work loss. ACC, Wellington
Accident Compensation Corporation (2004) New Zealand acute low back pain guide. Incorporating the guide to assessing psychosocial ‘yellow flags’ in acute low back pain. Accident Compensation Corporation, Wellington
Nicholas MK, Linton SJ, Watson PJ, Main CJ (2011) Early identification and management of psychological risk factors (“yellow flags”) in patients with low back pain: a reappraisal. Phys Ther 91:737–753
Main CJ, de Williams AC (2002) Musculoskeletal pain. BMJ Br Med J 325(7363):534–537
Kendall NA, Linton SJ, Main CJ (1997) Guide to assessing psychosocial yellow flags in acute low back pain: risk factors for long-term disability and work loss. Accident Rehabilitation and Compensation Insurance Corporation of New Zealand and the National Health Committee, Wellington
Chou R, Shekelle P (2010) Will this patient develop persistent disabling low back pain? JAMA 03:1295–1302. https://doi.org/10.1001/jama.2010.344
Shaw WS, Pransky G, Winters T, Tveito TH, Larson SM, Roter DL (2009) Does the presence of psychosocial “yellow flags” alter patient-provider communication for work-related, acute low back pain? J Occup Environ Med 51:1032–1040
Shaw WS, van der Windt DA, Main CJ, Loisel P, Linton SJ, “Decade of the Flags” Working Group (2009) Early patient screening and intervention to address individual-level occupational factors (“blue flags”) in back disability. J Occup Rehabil 19:64–80. https://doi.org/10.1007/s10926-008-9159-7
Mannion AF, Junge A, Taimela S, Müntener M, Lorenzo K, Dvorak J (2001) Active therapy for chronic low back pain: part 3. Factors influencing self-rated disability and its change following therapy. Spine 26:920–929
Foster NE, Bishop A, Thomas E, Main C, Horne R, Weinman J, Hay E (2008) Illness perceptions of low back pain patients in primary care: what are they, do they change and are they associated with outcome? Pain 136:177–187. https://doi.org/10.1016/j.pain.2007.12.007
Foster NE, Thomas E, Bishop A, Dunn KM, Main CJ (2010) Distinctiveness of psychological obstacles to recovery in low back pain patients in primary care. Pain 148:398–406. https://doi.org/10.1016/j.pain.2009.11.002
Hill JC, Whitehurst DGT, Lewis M et al (2011) Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet 378:1560–1571. https://doi.org/10.1016/S0140-6736(11)60937-9
Balagué F, Mannion AF, Pellisé F, Cedraschi C (2007) Clinical update: low back pain. Lancet 369:726–728
Hill JC, Fritz J (2011) Psychosocial influences on low back pain, disability, and response to treatment. Phys Ther 91:712–721. https://doi.org/10.2522/ptj.20100280
Shearer HM, Carroll LJ, Wong JJ, Côté P, Varatharajan S, Southerst D et al (2015) Are psychological interventions effective for the management of neck pain and whiplash-associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Spine J . https://doi.org/10.1016/j.spinee.2015.08.011
Monticone M, Cedraschi C, Ambrosini E, Rocca Bet al (2015) Cognitive-behavioural treatment for subacute and chronic neck pain. Cochrane Database Syst Rev (5):CD010664. https://doi.org/10.1002/14651858.D010664
Brox JI, Storheim K, Grotle M, Tveito TH, Indahl A, Eriksen HR (2008) Systematic review of back schools, brief education, and fear-avoidance training for chronic low back pain. Spine J 8(6):948–958
Mannion AF, Brox JI, Fairbank JC (2013) Comparison of spinal fusion and nonoperative treatment in patients with chronic low back pain: long-term follow-up of three randomized controlled trials. Spine J 13:1438–1448. https://doi.org/10.1016/j.spinee.2013.06.101
Haldeman S, Nordin M, Outerbridge G, Hurwitz EL, Hondras M, Brady O, Kopansky-Giles D, Ford T, Acaroğlu E (2015) Creating a sustainable model of spine care in underserved communities: the World Spine Care (WSC) charity. Spine J 15:2303–2311
Cedraschi C, Allaz AF (2005) How to identify patients with a poor prognosis in daily clinical practice. Best Pract Res Clin Rheumatol 19:577–591
Hoogendoorn WE, van Poppel MN, Bongers PM et al (2000) Systematic review of psychosocial factors at work and private life as risk factors for back pain. Spine 25:2114–2125
Nordin M, Hiebert R, Pietrek M, Alexander M, Crane M, Lewis S (2002) Association of comorbidity and outcome in episodes of nonspecific low back pain in occupational populations. J Occup Environ Med 44:677–684
Pincus T, Burton AK, Vogel S, Field AP (2002) A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine 27:109–120
Linton SJ (2000) A review of psychological risk factors in back and neck pain. Spine 25:1148–1156
Van Tulder M, Koes B, Bombardier C (2002) Low back pain. Best Pract Res Clin Rheumatol 16:761–775
Mousavi SJ, Akbari ME, Mehdian H et al (2011) Low back pain in Iran: a growing need to adapt and implement evidence-based practice in developing countries. Spine 36:E638–E646
Widanarko B, Legg S, Devereux J, Stevenson M (2012) Raising awareness of psychosocial factors in the occurrence of low back symptoms in developing countries. Work 41(Suppl 1):5734–5736
Widanarko B, Legg S, Stevenson M, Devereux J, Jones G (2013) Prevalence of low back symptoms and its consequences in relation to occupational group. Am J Ind Med 56:576–589. https://doi.org/10.1002/ajim.22116
Widanarko B, Legg S, Devereux J, Stevenson M (2015) Interaction between physical and psychosocial work risk factors for low back symptoms and its consequences amongst Indonesian coal mining workers. Appl Ergon 46:158–167
Sealetsa OJ, Thatcher A (2011) Ergonomics issues among sewing machine operators in the textile manufacturing industry in Botswana. Work 38:279–289. https://doi.org/10.3233/WOR-2011-1131
van Vuuren B, Zinzen E, van Heerden HJ, Becker P, Meeusen R (2005) Psychosocial factors related to lower back problems in a South African manganese industry. J Occup Rehab 15:215–225
van Vuuren BJ, van Heerden HJ, Becker PJ, Zinzen E, Meeusen R (2006) Fear-avoidance beliefs and pain coping strategies in relation to lower back problems in a South African steel industry. Eur J Pain 10:233–239
van Vuuren B, Zinzen E, van Heerden HJ, Becker PJ, Meeusen R (2007) Work and family support systems and the prevalence of lower back problems in a South African steel industry. J Occup Rehabil 17:409–421
Mariammal T, Jaisheeba AA, Sornaraj R (2012) Occupation influenced physical illness observed among teachers of Thoothukudi town. Int J PharmTech Res 4:1274–1278
Erick PN, Smith DR (2014) Low back pain among school teachers in Botswana, prevalence and risk factors. BMC Musculoskelet Disord 30(15):359
Beyen TK, Mengestu MY, Zele YT (2013) Low back pain and associated factors among teachers in Gondar town, North Gondar, Amhara region, Ethiopia. Occup Med Health Aff 1:127
Sikiru L, Shmaila H (2009) Prevalence and risk factors of low back pain among nurses in Africa: Nigerian and Ethiopian specialized hospitals survey study. East Afr J Public Health 6:22–25
Omokhodion FO, Sanya AO (2003) Risk factors for low back pain among office workers in Ibadan, Southwest Nigeria. Occup Med 53:287–289
Tait RC, Chibnall JT (2001) Work injury management of refractory low back pain: relations with ethnicity, legal representation and diagnosis. Pain 91:47–56
Chibnall JT, Tait RC (2009) Long-term adjustment to work-related low back pain: associations with socio-demographics, claim processes, and post-settlement adjustment. Pain Med 10:1378–1388. https://doi.org/10.1111/j.1526-4637.2009.00738.x
Costa-Black KM, Loisel P, Anema JR, Pransky G (2010) Back pain and work. Best Pract Res Clin Rheumatol 24:227–240. https://doi.org/10.1016/j.berh.2009.11.007
Yang H, Haldeman S, Lu ML, Baker D (2016) Low back pain prevalence and related workplace psychosocial risk factors: a study using data from the 2010 National Health Interview Survey. J Manip Physiol Ther. https://doi.org/10.1016/j.jmpt.2016.07.004
Yang H, Hitchcock E, Haldeman S, Swanson N, Lu ML, Choi B, Nakata A, Baker D (2006) Workplace psychosocial and organizational factors for neck pain in workers in the United States. Am J Ind Med 59:549–560. https://doi.org/10.1002/ajim.22602
Louw QA, Morris LD, Grimmer-Somers K (2007) The prevalence of low back pain in Africa: a systematic review. BMC Musculoskelet Disord 8:105
Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J, Maher C (2010) An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 19:2075–2094
Savigny P, Kuntze S, Watson P et al (2009) Low back pain: early management of persistent non-specific low back pain. National Institute of Clinical Evidence, London. http://www.nice.org.uk/CG88. Accessed 10 Nov 2016
Major-Helsloot ME, Crous LC, Grimmer-Somers K, Louw QA (2014) Management of LBP at primary care level in South Africa: up to standards? Afr Health Sci 14:698–706
Wong JJ, Côté P, Sutton DA, Randhawa K, Yu H, Varatharajan S et al (2016) Clinical practice guidelines for the noninvasive management of low back pain: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain. https://doi.org/10.1002/ejp.931
Lin IB, O’Sullivan PB, Coffin JA, Mak DB, Toussaint S, Straker LM (2012) ‘I am absolutely shattered’: the impact of chronic low back pain on Australian Aboriginal people. Eur J Pain 16:1331–1341
Lin IB, O’Sullivan PB, Coffin JA, Mak DB, Toussaint S, Straker LM (2013) Disabling chronic low back pain as an iatrogenic disorder: a qualitative study in Aboriginal Australians. BMJ Open. 2013 Apr 9;3(4). pii: e002654. https://doi.org/10.1136/bmjopen-2013-002654
Lin I, O’Sullivan P, Coffin J, Mak DB, Toussaint S, Straker L (2014) ‘I can sit and talk to her’: Aboriginal people, chronic low back pain and healthcare practitioner communication. Aust Fam Phys 43:320–324
Lin IB, Coffin J, O’Sullivan PB (2016) Using theory to improve low back pain care in Australian Aboriginal primary care: a mixed method single cohort pilot study. BMC Fam Pract 17:44. https://doi.org/10.1186/s12875-016-0441-z
Weiser S, Rossignol M (2006) Triage for nonspecific lower-back pain. Clin Orthop Relat Res 443:147–155
Schouten BC, Meeuwesen L (2006) Cultural differences in medical communication: a review of the literature. Patient Educ Couns 64:21–34
Meeuwesen L, Tromp F, Schouten BC, Harmsen JA (2007) Cultural differences in managing information during medical interaction: how does the physician get a clue? Patient Educ Couns 67:183–190
Shahid S, Finn LD, Thompson SC (2009) Barriers to participation of Aboriginal people in cancer care: communication in the hospital setting. MJA 190:574–579
Holt N, Pincus T (2016) Developing and testing a measure of consultation-based reassurance for people with low back pain in primary care: a cross-sectional study. BMC Musculoskelet Disord 17:277. https://doi.org/10.1186/s12891-016-1144-2
Pincus T, Holt N, Vogel S, Underwood M, Savage R, Walsh DA, Taylor SJ (2013) Cognitive and affective reassurance and patient outcomes in primary care: a systematic review. Pain 154:2407–2416. https://doi.org/10.1016/j.pain.2013.07.019
Burton AK, Waddell G, Tillotson KM, Summerton N (1999) Information and advice to patients with back pain can have a positive effect. A randomized controlled trial of a novel educational booklet in primary care. Spine 24:2484–2491
McClune T, Burton AK, Waddell G (2002) Whiplash associated disorders: a review of the literature to guide patient information and advice. Emerg Med J 19:499–506
Mc Clune T, Burton AK, Main C (2003) Evaluation of an evidence based patient educational booklet for management of whiplash associated disorders. Emerg Med J 20:1–4
Holt N, Pincus T, Vogel S (2015) Reassurance during low back pain consultations with GPs: a qualitative study. Br J Gen Pract 65:e692–e701. https://doi.org/10.3399/bjgp15X686953
Nordin M, Randhawa K, Torres P, Yu H, Haldeman S, Brady O et al The Global Spine Care Initiative: a systematic review for the assessment of spinal disorders in populations with limited resources and in low‑ and middle‑income communities. Eur Spine J. https://doi.org/10.1007/s00586-017-5446-3
Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJ, Ostelo RW, Guzman J et al (2014) Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database Syst Rev (9):CD000963
Napier AD, Ancarno C, Butler B, Calabrese J, Chater A, Chatterjee H et al (2014) Culture and health. Lancet 384:1607–1639
Spitzer RL, Kroenke K, Williams JB (1999) Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA 42:423–428
Kroenke K, Spitzer R, Williams JBW (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613
Krebs EE, Lorenz KA, Bair MJ, Damush TM, Wu J, Sutherland JM, Asch SM, Kroenke K (2009) Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference. Gen Intern Med 24(6):733–738. https://doi.org/10.1007/s11606-009-0981-1
Waddell G, Newton M, Henderson I, Somerville D, Main CJ (1993) A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 52:157–168
Linton SJ, Vlaeyen J, Ostelo R (2002) The back pain beliefs of health care providers: are we fear-avoidant? J Occup Rehab 12:223–232
Hill JC, Dunn KM, Lewis M et al (2008) A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis Rheum 59(5):632–641. https://doi.org/10.1002/art.23563
Deyo RA, Battie M, Beurskens AJ, Bombardier C, Croft P, Koes B, Malmivaara A, Roland M, Von Korff M, Waddell G (1998) Outcome measures for low back pain research: a proposal for standardized use. Spine 23(18):2003–2013
Mannion AF, Elfering A, Staerkle R, Junge A, Grob D, Semmer NK, Jacobshagen N, Dvorak J, Boos N (2005) Outcome assessment in low back pain: how low can you go? Eur Spine J 14(10):1014–1026
Beaton DE, Bombardier C, Guillemin F, Ferraz MB (2000) Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 25:3186–3191
Guillemin F, Bombardier C, Beaton D (1993) Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol 46:1417–1432
Gandek B, Ware JE Jr, IQOLA Group (1998) Methods for validating and norming translations of health status questionnaires: the IQOLA project approach. J Clin Epidemiol 51:953–959
Guyatt GH (1993) The philosophy of health-related quality of life translation. Qual Life Res 2:461–465
Kortum E, Leka S, Cox T (2010) Psychosocial risks and work-related stress in developing countries: health impact, priorities, barriers and solutions. Int J Occup Med Environ Health 23:225–238
Kortum E, Leka S, Cox T (2011) Perceptions of psychosocial hazards, work-related stress and workplace priority risks in developing countries. J Occup Health 53:144–155
Main CJ, Spanswick CC (2000) Pain management. Churchill Livingstone, Edinburgh
van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A et al; COST B13 Working Group on Guidelines for the Management of Acute Low Back Pain in Primary Care (2006) European guidelines for the management of acute non-specific low back pain in primary care, COST Action B13. Eur Spine J 15(Suppl 2):S169–S191. http://www.backpaineurope.org
Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F et al; COST B13 Working Group on Guidelines for Chronic Low Back Pain (2006) European guidelines for the management of chronic non-specific low back pain, COST Action B13. Eur Spine J 15(Suppl 2):S192–S300. http://www.backpaineurope.org
Main CJ, George SZ (2011) Psychologically informed practice for management of low back pain: future directions in practice and research. Phys Ther 91:820–824
Chehade MJ, Burgess TA, Bentley DJ (2011) Ensuring quality of care through implementation of a competency-based musculoskeletal education framework. Arthritis Care Res 63:58–64
Chehade MJ, Gill TK, Kopansky-Giles D, Schuwirth L, Karnon J, McLeish P et al (2016) Building multidisciplinary health workforce capacity to support the implementation of integrated, people-centred models of care for musculoskeletal health. Best Pract Res Clin Rheumatol 30:559–584
Verbeek J, Sengers MJ, Riemens L, Haafkens J (2004) Patient expectations of treatment for back pain. A systematic review of qualitative and quantitative studies. Spine 29:2309–2318
Charles C, Gafni A, Whelan T (1997) Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med 44:681–692
Kravitz RL (2001) Measuring patients’ expectations and requests. Ann Intern Med 134:881–888
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
The Global Spine Care Initiative and this study were funded by Grants from the Skoll Foundation and NCMIC Foundation. World Spine Care provided financial management for this project. The funders had no role in study design, analysis, or preparation of this paper.
Conflicts of interest
CC declares no conflicts of interest. MN declares funding from Skoll Foundation and NCMIC Foundation through World Spine Care; Co-Chair, World Spine Care Research Committee. Palladian Health, Clinical Policy Advisory Board member. Book Royalties Wolters Kluwer and Springer. Honoraria for speaking at research method courses. SH declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. Clinical Policy Advisory Board and stock holder, Palladian Health. Advisory Board, SpineHealth.com. Book Royalties, McGraw Hill. Travel expense reimbursement—CMCC Board. KR declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. DKG declares travel expenses: CMCC to present at the WSC Spine Conference in Botswana. CDJ declares she is President of Brighthall Inc. RC declares funding from AHRQ to conduct systematic reviews on treatments for low back pain within last 2 years. Honoraria for speaking at numerous meetings of professional societies and non-profit groups on topics related to low back pain (no industry sponsored talks). EH declares he is a consultant for: RAND Corporation; EBSCO Information Services; Southern California University of Health Sciences; Western University of Health Sciences Data and Safety Monitoring Committee. Chair, Palmer Center for Chiropractic Research. Research Committee Co-chair, World Spine Care. PC is funded by a Canada Research Chair in Disability Prevention and Rehabilitation at the University of Ontario Institute of Technology, and declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. Canadian Institutes of Health Research Canada. Research Chair Ontario Ministry of Finance. Financial Services Commission of Ontario. Ontario Trillium Foundation, ELIB Mitac. Fond de Recherche and Sante du Quebec.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Cedraschi, C., Nordin, M., Haldeman, S. et al. The Global Spine Care Initiative: a narrative review of psychological and social issues in back pain in low- and middle-income communities. Eur Spine J 27 (Suppl 6), 828–837 (2018). https://doi.org/10.1007/s00586-017-5434-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-017-5434-7