Risk and Prognostic Factors in Low Back Pain: Psychosocial prognostic factors
While the evidence implicating psychosocial factors in the onset of back pain is limited, there is considerably more evidence relating these factors to the transition from acute to chronic back pain.
A cutting-edge review on fear-avoidance and its consequences concluded that pain-related fear and avoidance appear to be an essential feature in the development of a chronic problem for a substantial number of patients with musculoskeletal pain.
Conclusions based on the evidence from thirty-seven studies and supported by two or more good-quality prspective trials were as follows:
- psychosocial variables are clearly linked to the transition from acute to chronic pain and disability
- psycosocial factors are aassociated with reported onset of pain
- psychosocial variables generally have more impact than biomedical or biomechanical factors on disability
- cognitive factors are related to the development of pain and disability--especially passive copping, catastrophising, and fear-avoidance.
- depression, anxiety and distress are related to pain and disbility
- self-perceived poor health is related to chronic pain and disability
- psychosocial factors may be used as predictors of the reisk of developing long-term pain and disability
Risk and Prognostic Factors in Low Back Pain: Biomechanical prognostic factors
Biomechanical factors are important both in the causation of an episode of back pain and in its perpetuation and aggravation. The majority of spinal pain is seen as varying in intensity with the patient's activity and is almost always aggravated by mechanical factors.Indeed, this important report referred to activity-related spinal disorders, with the clear assumption of the importance of day-to-day and postures that influence patients' pain.
Various reports have investigated the role of physical loading strategies in symptom response--these highlight the effect that normal mechanical loads, such as sitting, walking, and lying, have on aggravating or relieving symptoms. The common picture is of symptoms aggravated in positions involving flexion (sitting, rising from sitting, bending, driving) and improvement when walking, or being generally active, which are positions of extension.
Controlling early morning lumbar flexion is a form of self-care that can help develop a sense of control or mastery over low back pain, and thereby build confidence and improve outcome." McKenzie had previously identified the morning as a time when patients were frequently worse and at a risk of suffering a relapse or exacerbation.
Risk and Prognostic Factors in Low Back Pain: Individual and Clinical Prognostic Factors
History of previous back pain is both a risk factor for future back pain and a prognostic factor for prolonged symptoms. Reported leg at onset is associated with poor outcomes and a greater likelihood of developing chronic symptoms. Centralisation of leg pain, where distal limb pain is immediately or eventually abolished in response to loading strategies, has been shown to be a predictor of good outcomes.
Risk and Prognostic Factors in Low Back Pain: Onset
Although mechanical factors are associated with back pain and can therefore be seen as predisposing factors, onset is not always related to a specific event. Patients often report the precipitation factor involved flexion activities, such as lifting and bending. Generally however, more patients report back pain that commenced for no apparent reason.
The degree to which contemporary lifestyles are dominated by activities that onvolve flexion should thus be borne in mind; this may be sustained as in sitting or repeated motions such as bending. Sitting is the most common posture in today's workplace, particularly in industry and business.Three-quarters of all workers in industrial countries have sedentary jobs. About 45% of employed Americans work in offices. Many display poor posture and report increased pain when sitting.
