The causes of low back pain: a network analysis

Beliefs regarding the cause of low back pain differ between individual sufferers and health care professionals. One consequence of this is the potential acquisition of maladaptive attitudes and behaviour in relation to pain, and increases in the utilisation of primary care services (Health Expect.3(3) (2000) 161). Methods that have been used to elicit the causal interpretation of social phenomena are varied yet they are unable to categorically demonstrate the different weightings or levels of importance that individuals may assign. The diagram method of network analysis allows individuals to spontaneously consider pathways they believe to be critical to a target event and to determine the strength of those pathways. Seventy-one completed diagrams indicating the causes that sufferers perceived to be related to low back pain were analysed. The mean number of direct causal paths was 5.61 (SD=3.25) and mean number of indirect causal links was 1.16 (SD=2.34). A significant correlation between path frequency and path strength was also found (r=0.76, p=0.001). Sufferers do not have an overtly complex view of the causative factors of low back pain but were able to define four core contributory causes (disc, sciatica, lifting, and injury) and one indirect pathway between lifting and injury. There was a clear delineation between external (biomedical) and internal (person-related) factors that were attributed to low back pain acquisition. By determining these causal attributions it is proposed that treatment packages could be tailored to address biases in thinking. This may be particularly useful for those individuals who attribute their pain as a consequence of external (or biomedical) causes.