Biopsychosocial risk factors for the transition from acute to chronic back pain: A prospective cohort study

Biopsychosocial mechanisms are assumed to underlie the chronification of back pain; however, potentially relevant factors have mainly been examined in isolation rather than within comprehensive aetiological models. This study investigated risk factors of chronic back pain based on a current biopsychosocial model for persistent somatic symptoms.

Within the prospective cohort study IDRIS ("From the identification of biopsychosocial risk factors to an increase in pain-related self-efficacy - The online-based conveyance of an explanatory model for chronic back pain"), German adults with (sub)acute back pain (< 12 weeks) completed online questionnaires on biopsychosocial variables at baseline, 1-month and 3-month follow-up. Possible predisposing and maintaining predictors of chronic back pain at 3 months were tested in linear regression models.

Between December 2022 and July 2024, 280 individuals from the general population with (sub)acute back pain (mean age 37.52 (SD 12.41) years; 65 % female) completed all assessments. Predictors of chronic back pain at 3 months were dysfunctional symptom expectations at 1-month follow-up (ß = 0.25, p < 0.001) and high baseline pain severity grades (highest grade: ß = 0.18, p < 0.01). Other postulated variables did not predict pain chronification.

This study supports the role of negative pain-related beliefs in the transition from acute to chronic back pain and suggests addressing dysfunctional symptom expectations in secondary prevention interventions to mitigate the risk of pain chronification. Future research should assess postulated predisposing factors for chronic back pain in clinical populations over longer timeframes to evaluate their long-term predictive value.

Stiftung Psychosomatik der Wirbelsäulenerkrankungen.