Discussion paper: what happened to the ‘bio’ in the bio-psycho-social model of low back pain?
- 25 June 2011
- journal article
- review article
- Published by Springer Science and Business Media LLC in European Spine Journal
- Vol. 20 (12), 2105-2110
- https://doi.org/10.1007/s00586-011-1886-3
Abstract
Over 20 years ago the term non-specific low back pain became popular to convey the limitations of our knowledge of the pathological source of most people’s low back pain. Knowledge of underlying pathology has advanced little since then, despite limited improvements in outcomes for patients with low back pain. This paper discusses potential misunderstandings related to diagnostic studies in the field of low back pain and argues that future diagnostic studies should include and investigate pathological sources of low back pain. Six potential misunderstandings are discussed. (1) Until diagnosis is shown to improve outcomes it is not worth investigating; (2) without a gold standard it is not possible to investigate diagnosis of low back pain; (3) the presence of pathology in some people without low back pain means it is not important; (4) dismissal of the ability to diagnose low back pain in clinical guidelines is supported by the same level of evidence as recommendations for therapy; (5) suggesting use of a diagnostic test in research is misinterpreted as endorsing its use in current clinical practice; (6) we seem to have forgotten the ‘bio’ in biopsychosocial low back pain. We believe the misunderstandings presented in this paper partly explain the lack of investigation into pathology as an important component of the low back pain experience. A better understanding of the biological component of low back pain in relation, and in addition, to psychosocial factors is important for a more rational approach to management of low back pain.Keywords
This publication has 26 references indexed in Scilit:
- The Association Between Lumbar Disc Degeneration and Low Back PainSpine, 2010
- Systematic reviews of low back pain prognosis had variable methods and results—guidance for future prognosis reviewsJournal of Clinical Epidemiology, 2009
- Prevalence and Pattern of Lumbar Magnetic Resonance Imaging Changes in a Population Study of One Thousand Forty-Three IndividualsSpine, 2009
- Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back painEuropean Spine Journal, 2008
- Low back pain research priorities: a survey of primary care practitionersBMC Family Practice, 2007
- A Gold Standard Evaluation of the “Discogenic Pain” Diagnosis as Determined by Provocative DiscographySpine, 2006
- Symptoms and radiographic osteoarthritis: not as discordant as they are made out to be?Annals Of The Rheumatic Diseases, 2006
- Chapter 3 European guidelines for the management of acute nonspecific low back pain in primary careEuropean Spine Journal, 2006
- The Longitudinal Assessment of Imaging and Disability of the Back (LAIDBack) StudySpine, 2001
- 1987 Volvo Award in Clinical Sciences: A New Clinical Model for the Treatment of Low-Back PainSpine, 1987