Determinants of chronic disability related to low back pain: Towards an integrative biopsychosocial model

Purpose : Since the early 1990s, numerous prospective studies have been published on the determinants of chronic disability related to low back pain (LBP) of non-specific origin whose human and financial costs are enormous. The significant contribution of psychosocial factors is being increasingly recognized. However, additional efforts are needed to clarify their role and to improve the interventions. The purpose of this theoretical paper is to propose a coherent organization of the medical and psychosocial determinants identified in prospective studies into a conceptual framework. Method : Several models available in the field of pain and disability as well as in health psychology were reviewed. Results : A recent version of the stress coping model was chosen and adapted to the problem. The adapted model suggests that stress, particularly that caused by the pain associated with LBP, could have a negative impact on the outcome either: (1) indirectly through the negative emotional responses that it produces, which can cause biological or behavioural changes; or (2) directly through the biological or behavioural changes, which can in turn negatively affect the emotional response. Conclusions : The proposed biopsychosocial model assumes that LBP-related chronic disability is possibly, in some cases, a stress-related disorder. Its empirical verification in LBP could particularly improve the understanding of the interrelationships between certain variables.