Cognitive-behavioral therapy and psychosocial factors in low back pain: directions for the future.
METHODS
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).


OBJECTIVE
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.


BACKGROUND
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.


METHODS
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.


CONCLUSIONS
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.
Pincus
Tamar
T
Royal Holloway, University of London, London, United Kingdom, Maastricht University, Maastricht, The Netherlands. t.pincus@rhbnc.ac.uk
Vlaeyen
Johan W S
JW
Kendall
Nick A S
NA
Von Korff
Michael R
MR
Kalauokalani
Donna A
DA
Reis
Shmuel
S
D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000639:trends; D019317:Evidence-Based Medicine; D005239:Fear / Q000523:psychology; D006801:Humans; D017116:Low Back Pain / Q000209:etiology / Q000523:psychology* / Q000628:therapy*; D008960:Models, Psychological; D010146:Pain / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010819:Physician's Role; D011320:Primary Health Care; D012307:Risk Factors