In the first systematic review , the patients ' or HCPs ' overall judgment about the likely evolution of LBP was the factor most strongly linked to poor outcome , with predictive validity similar to that of multidimensional scales .
This result may be explained by the implicit aggregation of many prognostic factors underlying this judgment and suggests the relevance of considering the patients from biopsychosocial and longitudinal points of view .
It is unlikely that any intervention focusing on a single factor would ever fit the needs of most patients ; interventions targeting determinants from several fields ( mainly psychosocial , biomechanical , and occupational ) may be more relevant .
Finally , in the third study , the prevalence of psychosocial comorbidity in chronic LBP patients was not found to be significantly higher than in other patients consulting in primary care .
Rather than specifically screening for psychosocial conditions , this suggests taking into account any potential comorbidity in patients with chronic LBP , as in other patients .
As this condition is illustrative of many situations encountered in primary care , the strategies proposed here may benefit most patients consulting in this setting
Non-specific low back pain ( LBP ) affects many people and has major socio-economic consequences .
Traditional therapeutic strategies , mainly focused on biomechanical factors , have had moderate and short-term impact .
Certain psychosocial factors have been linked to poor prognosis of LBP and they are increasingly considered as promising targets for management of LBP .
Primary health care providers ( HCPs ) are involved in most of the management of people with LBP and they are skilled in providing comprehensive care , including consideration of psychosocial dimensions .
This review aims to discuss three pieces of recent research focusing on psychosocial issues in LBP patients in primary care .
A Cluster-Randomised Trial Evaluating an Intervention for Patients with Stress-Related Mental Disorders and Sick Leave in Primary Care
Objective : Mental health problems often affect functioning to such an extent that they result in sick leave . The worldwide reported prevalence of mental health problems in the working population is 10%–18 % . In developed countries , mental health problems are one of the main grounds for receiving disability benefits . In up to 90 % of cases the cause is stress-related , and health-care utilisation is mainly restricted to primary care . The aim of this study was to assess the effectiveness of our Minimal Intervention for Stress-related mental disorders with Sick leave ( MISS ) in primary care , which is intended to reduce sick leave and prevent chronicity of symptoms . Design : Cluster-r and omised controlled educational trial . Setting : Primary health-care practice s in the Amsterdam area , The Netherl and s. Participants : A total of 433 patients ( MISS n = 227 , usual care [ UC ] n = 206 ) with sick leave and self-reported elevated level of distress . Interventions : Forty-six primary care physicians were r and omised to either receive  training in the MISS or to provide UC . Eligible patients were screened by mail . Outcome Measures : The primary outcome measure was duration of sick leave until lasting full return to work . The secondary outcomes were levels of self-reported distress , depression , anxiety , and somatisation . Results : No superior effect of the MISS was found on duration of sick leave ( hazard ratio 1.06 , 95 % confidence interval 0.87–1.29 ) nor on severity of self-reported symptoms . Conclusions : We found no evidence that the MISS is more effective than UC in our study sample of distressed patients . Continuing research should focus on the potential beneficial effects of the MISS ; we need to investigate which elements of the intervention might be useful and which elements should be adjusted to make the MISS effective
In the first systematic review , the patients ' or HCPs ' overall judgment about the likely evolution of LBP was the factor most strongly linked to poor outcome , with predictive validity similar to that of multidimensional scales .
This result may be explained by the implicit aggregation of many prognostic factors underlying this judgment and suggests the relevance of considering the patients from biopsychosocial and longitudinal points of view .
It is unlikely that any intervention focusing on a single factor would ever fit the needs of most patients ; interventions targeting determinants from several fields ( mainly psychosocial , biomechanical , and occupational ) may be more relevant .
Finally , in the third study , the prevalence of psychosocial comorbidity in chronic LBP patients was not found to be significantly higher than in other patients consulting in primary care .
Rather than specifically screening for psychosocial conditions , this suggests taking into account any potential comorbidity in patients with chronic LBP , as in other patients .
As this condition is illustrative of many situations encountered in primary care , the strategies proposed here may benefit most patients consulting in this setting
Non-specific low back pain ( LBP ) affects many people and has major socio-economic consequences .
Traditional therapeutic strategies , mainly focused on biomechanical factors , have had moderate and short-term impact .
Certain psychosocial factors have been linked to poor prognosis of LBP and they are increasingly considered as promising targets for management of LBP .
Primary health care providers ( HCPs ) are involved in most of the management of people with LBP and they are skilled in providing comprehensive care , including consideration of psychosocial dimensions .
This review aims to discuss three pieces of recent research focusing on psychosocial issues in LBP patients in primary care .