Biopsychosocial care for chronic back pain

Supporting evidence looks promising but far from complete Chronic back pain is a leading cause of disability that has a major impact on patients, doctors, healthcare systems, and workplaces.1 Despite growing use in some countries of spinal imaging, opioid analgesics, spinal injections, and spinal fusion surgery, disability from back pain has increased.2 Chronic low back pain is increasingly recognized as often being more than simply an anatomical or physiological problem related to intervertebral discs, facet joints, sacroiliac joints, paravertebral muscles, or other spinal structures.3 Accordingly, multidisciplinary rehabilitation programs have evolved to tackle multiple facets of the condition, but their optimal design, effectiveness, and costs have remained uncertain. Uncertainties have in turn spurred an expanding clinical trial literature on these programs, and the linked paper by Kamper and colleagues (doi:10.1136/bmj.h444) provides a new systematic review of the evidence on their effectiveness.4 Multidisciplinary rehabilitation programs acknowledge that although deranged anatomy or physiology contributes to back pain, psychological factors such as anxiety, depression, and a tendency to catastrophize may amplify or prolong pain.5 Similarly, social factors such as demands of work, the work environment, or legal action related to back pain affect the nature of pain …