Surprising Findings About Psychosocial Factors and Low Back Pain

In this paper researchers try to explain why treatment aimed at psychosocial factors did not have better results than usual care for low back pain (LBP) patients. Other studies have already shown there is an effect of psychosocial factors on LBP. It makes sense to think treatment aimed at those factors should be helpful. The results of their first study published earlier in 2005 were a surprise. They were certain a psychosocial approach would make a difference but it didn't.

Taking a look at why this might be so, the scientists suggest four areas:

  • Physicians' attitude
  • Physicians' behavior
  • Patient satisfaction
  • Patient compliance

    Doctors’ attitudes may be one way to explain the results. They found that the training session for the doctors helped steer them away from a biomedical model of LBP. However it didn't move them toward a behavior model as planned.

    Doctors’ behavior was another possible problem. Doctors didn't always follow the researchers' plan. For example patients in the psychosocial study group weren't supposed to be sent to physical therapy (PT) in the first six weeks. Yet 20 percent of the patients were given PT referrals anyway.

    Patient compliance may be a factor but the researchers couldn't say how or why. They did find out that patient satisfaction increased even though treatment focused on psychosocial factors didn't make a difference. Further study of this finding is planned.

    The authors conclude that knowing why something doesn't work is helpful. The information gathered from this study may give some insights into the causes and successes of treatment for low back pain.

    Petra Jellema, et al. Why is a Treatment Aimed at Psychosocial Factors Not Effective in Patients with (Sub)Acute Low Back Pain? In Pain. December 5, 2005. Vol. 118. No. 3. Pp. 350-359.

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