Low back pain: Identifying sub-groups, clinical prediction rules and measuring results

Abstract

Low back pain is a complex, multifactorial health problem with huge socioeconomic impact. The purpose of this brief review was to reconsider the use of the biopsychosocial model as a basis for subgrouping cases to support the stratification of care. Unfortunately, this model is unbalanced due to a lack of evidence around biological components, and so far offers risk based assessments centered mainly on a number of psychological and social factors as the principal means of stratification. Such prognostic models have modest predictive value and are highly susceptible to contamination by undisclosed influences as well as contextual bias. However, there is emerging evidence around mechanical, chemical and central sensitization factors as biological components that may be included both in diagnostic assessment and for their relationships to prognosis and treatment outcome. This offers the potential to ‘rebalance’ the biopsychosocial model of back pain without abandoning previously discovered outcome predictors.