Psychosocial factors in low back pain: letting go of our misconceptions can help management

The Lancet low back pain (LBP) series1 highlighted the important role of psychosocial factors in LBP and its associated disability. It is worth reflecting on what psychosocial factors are, and are not, in order to optimise management. Not all psychosocial factors are indicative of a mental health disorder which requires assessment and treatment by a dedicated mental health provider. For example, fear of movement is NOT necessarily a mental health disorder unless the individual meets the criteria for phobic disorder. While we need to competently identify patients with comorbid mental health disorders, such cases are the exception, not the rule. As such, many psychosocial factors (eg, fear of movement, distress about scan findings, depression related to a loss of valued activities, anxiety about the future, social stress) can be within the scope of musculoskeletal clinicians. We contend that the way we have categorised interventions for LBP into ‘physical’ or ‘psychological’ has created boundaries for what clinicians deem to be within their scope.2 We …