The literature strongly suggests that patients with long-standing
back pain often have several psychosocial problems, which in
turn are important predictors for chronicity [9,16,29]. Many patients
with chronic pain have suffered psychosocial traumas during
their life, which for some lead to psychological distress, e.g. anxiety,
depression and perhaps social isolation [10,29]. Providers
know this, and it may influence their attitude and communication
more or less consciously. Even when patients present with acute
low back pain, physicians have been shown to talk more and ask
more biomedical questions if the patients were in a high psychosocial
risk group [24]. This communication style is not considered
beneficial [6,22] and would induce a lower score on the 4HCS.