Skip to main content
Log in

Biopsychosocial Determinants of Chronic Disability and Low-Back Pain: A Review

  • Published:
Journal of Occupational Rehabilitation Aims and scope Submit manuscript

Abstract

It is well known that the human and financial costs related to sick leave due to Low-Back Pain (LBP) are substantial in a small percentage of workers. A better understanding of the predictive factors for chronic disability would allow interventions to be adapted and costs to be reduced. This paper is a critical review of recent prospective studies on the biopsychosocial factors predictive of nonreturn to work due to LBP. A sample of 18 prospective studies were systematically analyzed. Despite the limited number of prospective studies and their differences, some factors are promising indicators. These include a previous history of LBP, results of certain clinical tests, a subjective negative appraisal of one's ability to work, and job dissatisfaction. The role of certain psychological variables, including attitudes and beliefs, as well as coping strategies, is also emerging. Additional studies are necessary to confirm the importance of these factors, to specify the nature of the interrelationships among them, and to integrate them into a conceptual framework.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Biering-Sorensen F. A prospective study of low-back pain in a general population: 1. Occurrence, recurrence and aetiology. Scand J Rehab Med 1983; 15: 71–79.

    Google Scholar 

  2. Linton SJ, Hallden K. Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain. Clin J Pain 1998; 14: 209–215.

    Google Scholar 

  3. Loeser JD, Volinn E. Epidemiology of low-back pain. Neurosurgical Clinics North Am. 1991; 2: 713–718.

    Google Scholar 

  4. Waddell G. A new clinical model for the treatment of low-back pain. Spine 1987; 12: 632–644.

    Google Scholar 

  5. Duguay P, Massicotte P. Profil statistique des affections vertébrales survenues au Québec entre 1994 et 1996 et indemnisées par la CSST. IRSST 1999; 199 (à parâýtre).

  6. Allaire M, Dionne G, Saint-Michel P. Profil statistique des travailleurs du Québec ayant subi une affection vertébrale en 1987. Arch Mal Prof 1994; 55: 9–18.

    Google Scholar 

  7. Spitzer WO, Leblanc FE, Dupuis M, Abenhaim L, Bélanger AY, Bloch R, Bombardier C, Cruess RL, Drouin G, Duval-Hesler N, Laflamme J, Lamoureux G, Nachemson A, Pagé JJ, Rossignol M, Salmi LR, Salois-Arsenault S, Suissa S, Wood-Dauphinée S. 1987 Scientific approach to the assessment and management of activity-related spinal disorders. A monograph for clinicians–Report of the Quebec Task Force on Spinal Disorders. Spine 1987; 12(Suppl. 1): 59.

    Google Scholar 

  8. Coste J, Delecoeuillerie G, Cohen de Lara A, Le Parc JM, Paolaggi JB. Clinical course and prognostic factors in acute low-back pain: An inception cohort study in primary care practice. Br Med J 1994; 308: 577–580.

    Google Scholar 

  9. Paolaggi JB. Les lombalgies: analyse critique de l';état actuel des connaissances. Bull Académie Natle Méd 1996; 180: 1033–1052.

    Google Scholar 

  10. Cats-Baril WL, Frymoyer JW. Identifying patients at risk of becoming disabled because of low-back pain. The Vermont Rehabilitation Engineering Center Predictive Model. Spine 1991; 16: 605–607.

    Google Scholar 

  11. CSST. Accidents survenus entre 1994 et 1996. Fichier Info-Centre-CSST, Mise à jour 1er mars 1998.

  12. Frank JW, Kerr MS, Brooker AS, DeMaio SE, Maetzel A, Shannon HS, Sullivan TJ, Norman RW, Wells RP. Disability resulting from occupational low-back pain. Part I–What do we know about primary prevention? A review of the scientific evidence on prevention before disability begins. Spine 1996; 21: 2908–2917.

    Google Scholar 

  13. Frank JW, Brooker AS, DeMaio SE, Kerr MS, Maetzel A, Shannon HS, Sullivan TJ, Norman RW, Wells RP. Disability resulting from occupational low-back pain. Part II: What do we know about secondary prevention? A review of the scientific evidence on prevention before disability begins. Spine 1996; 21: 2918–2929.

    Google Scholar 

  14. Burton AK. Spine update. Back injury and work loss: Biomechanical and psychosocial influences. Spine 1997; 22: 2575–2580.

    Google Scholar 

  15. Frymoyer JW, Cats-Baril W. Predictors of low-back pain disability. Clin Orthop Rel Res 1987; 221: 89–98.

    Google Scholar 

  16. Gatchel RJ, Gardea MA. Psychosocial issues. Their importance in predicting disability, response to treatment, and search for compensation. Neurologic Clinics North Am. 1999; 17: 149–166.

    Google Scholar 

  17. Haldorsen EMH, Indahl A, Ursin H. Patients with low-back pain not returning towork. A 12-month follow-up study. Spine 1998; 23: 1202–1208.

    Google Scholar 

  18. Klenerman L, Slade PD, Stanley IM, Pennie B, Reilly JP, Atchison LE, Troup JDG, Rose MJ. The prediction of chronicity in patients with an acute attack of low-back pain in a general practice setting. Spine 1995; 20: 478–484.

    Google Scholar 

  19. Waddell G. Biopsychosocial analysis of low-back pain. Clin Rheumatol 1992; 6: 523–557.

    Google Scholar 

  20. Carey TS et al. The road to chronicity. The Back Letter July 1999; 19: 73, 82.

    Google Scholar 

  21. Gatchel RJ, Polatin PB, Mayer TG. The dominant role of psychosocial risk factors in the development of chronic low-back pain disability. Spine 1995; 20: 2702–2709.

    Google Scholar 

  22. Burton AK, Tillotson KM, Main CJ, Hollis S. Psychosocial predictors of outcome in acute and subchronic low-back trouble. Spine 1995; 20: 722–728.

    Google Scholar 

  23. Oleinick A, Gluck JV, Guire KE. Factors affecting first return to work following a compensable occupational back injury. Am J Ind Med 1996; 30: 540–555.

    Google Scholar 

  24. van der Weide WE, Verbeek JHAM, Sallé HJA, van dijk FJH. Prognostic factors for chronic disability from acute low-back pain in occupational health care. Scand J Work Environ Health 1999; 25: 50–56.

    Google Scholar 

  25. Gatchel RJ, Polatin PB, Kinney RK. Predicting outcome of chronic back pain using clinical predictors of psychopathology: A prospective analysis. Health Psychol 1995; 14: 415–420.

    Google Scholar 

  26. Epping-Jordan JE, Wahlgren DR, Williams RA, Pruitt SD, Slater MA, Patterson TL, Grant I, Webster JS, Atkinson JH. Transition to chronic pain in men with low-back pain: Predictive relationships among pain intensity, disability, and depressive symptoms. Health Psychol 1998; 17: 421–427.

    Google Scholar 

  27. Lanier DC, Stockton P. Clinical predictors of outcome of acute episodes of low-back pain. J Fam Pract 1988; 27: 483–489.

    Google Scholar 

  28. Boos N, Rieder R, Schade V, Spratt KF, Semmer N, Aebi M. The diagnostic accuracy of magnetic resonance imaging, work perception, and psychosocial factors in identifying symptomatic disc herniations. Spine 1995; 20: 2613–2625.

    Google Scholar 

  29. Deyo RA. Magnetic resonance imaging of the lumbar spine. N Engl J Med 1994; 331: 115, 116.

    Google Scholar 

  30. Jensen MC. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994; 331: 69–73.

    Google Scholar 

  31. Symonds TL, Burton AK, Tillotson KM, Main CJ. Do attitudes and beliefs influencework loss due to low-back trouble? Occup Med 1996; 46: 25–32.

    Google Scholar 

  32. Öhlund C, Lindström I, Eek C, Areskoug B, Nachemson A. The causality field (extrinsic and intrinsic factors) in industrial subacute low-back pain patients. Scand J Med Sci Sports 1996; 6: 98–111.

    Google Scholar 

  33. Rossignol M, Lortie M, Ledoux E. Comparison of spinal health indicators in predicting spinal status in a 1-year longitudinal study. Spine 1993; 18: 54–60.

    Google Scholar 

  34. Lindström I, Öhlund C, Nachemson A. Validity of patient reporting and predictive value of industrial physical work demands. Spine 1994; 19: 888–893.

    Google Scholar 

  35. Yassi A, Tate R, Cooper JE, Snow C, Vallentyne S, Khokhar JB. Early intervention for back-injured nurses at a large Canadian tertiary care hospital: An evaluation of the effectiveness and cost benefits of a two-year pilot project. Occup Med 1995; 45: 209–214.

    Google Scholar 

  36. Williams RA, Pruitt SD, Doctor JN, Epping-Jordan JE, Wahlgren DR, Grant I, Patterson TL, Webster JS, Slater MA, Atkinson JH. The contribution of job satisfaction to the transition from acute to chronic low-back pain. Arch Phys Med Rehab 1998; 79: 366–373.

    Google Scholar 

  37. Gervais S, Dupuis G, Véronneau F, Bergeron Y, Millette D, Avard J. Predictive model to determine cost/benefit of early detection and intervention in occupational low-back pain. J Occup Rehab 1991; 1: 113–131.

    Google Scholar 

  38. Eimer BN, Freeman A. Pain management psychotherapy. A practical guide. New York: John Wiley & Sons, Inc.,1998, p. 7.

    Google Scholar 

  39. Melzack R. In: Gatchel RJ, Turk DC, ed. Psychological factors in pain. Critical perspectives. New York: The Guilford Press, 1999, pp. 89–106.

    Google Scholar 

  40. Gatchel RJ. Perspectives on pain: A historical overview. In: Gatchel RJ, Turk DC, ed. Psychological factors in pain. Critical perspectives. New York: The Guilford Press, 1999, pp. 3–17.

    Google Scholar 

  41. Tait RC, Evaluation of treatment effectiveness in patients with intractable pain: Measures and methods. In: Gatchel RJ, Turk DC, ed. Psychological factors in pain. Critical perspectives. New York: The Guilford Press, 1999, pp. 457–480.

    Google Scholar 

  42. Feyer AM, Williamson A, Mandryk J, de Silva I, Healy S. Role of psychosocial risk factors in work-related low-back pain. Scand J Work Environ Health 1992; 18: 368–375.

    Google Scholar 

  43. Hemsley S, Broadhurst N, Colquhoun J. Low-back pain in mineral sand mine workers. Aust Fam Phys 1998; 27: 503–507.

    Google Scholar 

  44. Fordyce WE. Pain and suffering: What is the unit? Quality Life Res 1994; 3 (Suppl. 1): S51–S56.

    Google Scholar 

  45. Simmonds MJ, Kumar S, Lechelt E. Psychosocial factors in disabling low-back pain: Causes or consequences? Disability Rehabil 1996; 18: 161–168.

    Google Scholar 

  46. Gallagher RM, Williams RA, Skelly J, Haugh LD, Rauh V, Milhous R, Frymoyer J. Workers' compensation and return-to-work in low-back pain. Pain 1995; 61: 299–307.

    Google Scholar 

  47. Öhlund C, Lindström I, Areskoug B, Eek C, Peterson LE, Nachemson A. Pain behavior in industrial subacute low-back pain. Part 1. Reliability: Concurrent and predictive validity of pain behavior assessments. Pain 1994; 58: 201–209.

    Google Scholar 

  48. Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer, 1984.

    Google Scholar 

  49. Truchon M. Événements de vie anticipés et stress psychologique chez des couples en d´emarches reproductives. Thèse de doctorat, Université Laval, 1995.

  50. Turk DC, Flor H. Chronic pain: A biobehavioral perspective. In: Gatchel RJ, Turk DC, ed. Psychosocial factors and pain: Critical perspectives. New York: The Guilford Press, 1999, pp. 18–34.

    Google Scholar 

  51. Endler NS, Coubasson CMA, Fillion L. Coping with cancer: The evidence for the temporal stability of the French Canadian version of the Coping with Health, Injuries and Problems (CHIP). Person Indiv Differ 1998; 25: 711–717.

    Google Scholar 

  52. Carver CS, Scheier MF, Weintraub JK. Assessing coping strategies: A theoretically based approach. J Person Soc Psychol 1989; 56: 267–283.

    Google Scholar 

  53. Endler NS, Parker JDA, Summerfeldt LJ. Coping with health problems: Developing a reliable and valid multidimensional measure. Psychol Assess 1998; 10: 195–205.

    Google Scholar 

  54. Hogg-Johnson S, Frank JW, Rael E. Prognostic risk factor models for low-back pain: Why they have failed and a new hypothesis. Institute for Work & Health, Toronto, Working paper No. 19, April 1994, p. 24.

    Google Scholar 

  55. Dorvil H. Types de sociétés et de représentations du normal et du pathologique: la maladie physique, la maladie mentale. In: Traitéd'anthropologiemédicale, sous la direction de J. Dufresne, F. Dumont et Y. Martin. Presses de l'Université du Québec, Institut québécois de la recherche sur la culture et Presses Universitaires de Lyon, 1985, pp. 305–332.

  56. Weiser S, Cedraschi C. Psychological issues in the prevention of chronic low-back pain–A literature review. Baillière's Clin Rheumatol 1992; 6: 657–684.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Truchon, M., Fillion, L. Biopsychosocial Determinants of Chronic Disability and Low-Back Pain: A Review. J Occup Rehabil 10, 117–142 (2000). https://doi.org/10.1023/A:1009452019715

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1009452019715

Navigation