Transition from acute to chronic low back pain: A biopsychosocial perspective

Low back pain (LBP) is the most costly and the most common musculoskeletal condition in industrialised countries, and is the most common cause of disability particularly for those under the age of 4 5 . Most of disability and the associated costs relate to the condition when it becomes chronic. It is therefore necessary to study the factors that lead to chronicity, and the clinical predictors that can be used to warn clinicians against such an outcome. This review explores these predictors, as well as the beliefs and perceptions of practitioners about these predictors that inform their clinical decision-making that could impact on the patients' transition to chronicity. A number of these predictors of chronicity in LBP are beginning to be established, they include: Pain predictors: earlier literature categorises these predictors into three levels, primary or preinjury, secondary or pre chronicity and tertiary or chronic outcome predictors. Literature in recent times has pointed to psychological factors as being clearly associated with the development of chronicity. Disease related f actors: Few associations have been identified between the disease related factors and chronicity. O ccupational f actors: have been found to contribute significantly to the risk of chronicity. Workers with subacute LBP receiving workers compensation reported that stress, fear and beliefs about work correlated strongly with progression to chronicity.