Cognitive-Behavioral Therapy and Psychosocial Factors in... : Spine (original) (raw)

Primary Care

Directions for the Future

Pincus, Tamar PhD*; Vlaeyen, Johan W. S. PhD†; Kendall, Nick A. S. PhD‡; Von Korff, Michael R. ScD§; Kalauokalani, Donna A. MD, MPH∥; Reis, Shmuel MD¶

From *Royal Holloway, University of London, London, United Kingdom, †Maastricht University, Maastricht, The Netherlands, ‡University of Otago, Dunedin, New Zealand, the §Centre for Health Studies, Seattle, Washington, ∥Washington University, St. Louis, Missouri and ¶Bruce Rappaport Faculty of Medicine, Technion Haifa, Israel.

Acknowledgment date: September 18, 2000.

First revision date: February 21, 2001.

Second revision date: April 30, 2001.

Acceptance date: August 1, 2001.

Address correspondence to

Dr. Tamar Pincus

Department of Psychology

Royal Holloway

Egham, TW20 0EX

United Kingdom

E-mail: [email protected]

The manuscript submitted does not contain information about medical device(s).

No funds were received in support of this study.

Abstract

Study Design.

An amalgamated review of the current state of knowledge about psychosocial factors in low back pain (LBP), as presented at the plenary session at the Fourth International Forum on LBP Research in Primary Care (March 16–18, 2000, Israel).

Objectives.

To outline evidence-based theories that have lead to the identification of yellow flags (psychosocial risk factors for developing long-term disability) for nonspecific LBP. To discuss the role of clinicians in primary care in detecting and addressing these psychosocial factors and to outline future directions for research to clarify this role.

Summary of Background Data.

It is widely accepted that psychological and social factors play an important role in LBP; however, it is currently unclear which specific factors merit intervention to reduce the burden of disease.

Method.

The review is an integration based on the plenary session presented at the Fourth International Forum on LBP Research in Primary Care. The presentations included original research studies, a systematic review, and theoretical descriptions of models of risk and treatment.

Results.

There is good evidence to support the role of psychological risk factors at early stages of LBP in the development of long-term disability. There are evidence-based theories and models that provide directions for future interventions.

Conclusion.

In the treatment of psychological factors, the role of clinicians in primary care remains unclear. Further evidence is needed to identify specific psychological risk factors, primary care tools for their identification need developing, and interventions at different stages of LBP by different professionals need to be tested.