Better integration of psychosocial approaches
Despite major advances in our understanding of the physiology of the spine and nervous system,
these scientific advances have failed to explain pain intensity and chronicity in the case of ‘garden
variety’ nonspecific LBP [4,5]. On average, the current array of biomedical treatments for nonspecific
LBP offers only small incremental or temporary relief from pain, and some interventions come with a
significant risk of side effects or other negative outcomes [6]. An alternative is psychological interventions,
which offer similar benefits and fewer side effects [7,8], but their uptake and availability in
general medical settings have been slow [97,98].
Apart from providing psychotherapy services to patients, another option is to integrate psychologically
informed treatment strategies into physical treatments and consultations [97]. While the primary focus is to alter dysfunctional pain beliefs and increase physical activity, these treatments also
offer opportunities to address social factors influencing LBP management and functional recovery.
Problem-solving skills training might be useful to overcome barriers at work and home, communication
skills training could improve interpersonal coping and support, behavioural analysis might
improve insights about the social impacts of pain at home and assertiveness training could improve
effective communication within the workplace. All of these cognitive–behavioural strategies are
appropriate for addressing social challenges and promoting behaviour change