BIOBEHAVIORAL FACTORS AFFECTING PAIN AND DISABILITY IN LOW-BACK-PAIN - MECHANISMS AND ASSESSMENT

Patients with recurrent or persistent low back pain (LBP) and disabili ty represent sent a formidable challenge to physical therapists. Class ic models of disease and pain mechanisms do not adequately explain the commonly observed discrepancies between the extent of pathology and r eported pain, or the level of pain and disability. Research over the p ast decade that considers the interactive role of biological, environm ental, and psychological processes in pain and disability has supporte d the involvement of a number of biobehavioral factors in these condit ions. Physical therapists and other health care providers have become more aware of these factors and their impact on the evaluation, treatm ent, and management of LBP. Despite this recognition, little informati on is available that translates the implications of this research to d irect care within physical therapy practice. The purposes of this arti cle are (1) to provide an operational definition of biobehavioral fact ors; (2) to review the role of these factors in the clinical presentat ion of LBP, functional limitation, and disability; (3) to identify com monly used approaches for their recognition and quantification; (4) to illustrate how an understanding of biobehavioral factors can assist t he physical therapist in evaluation and treatment of patients with LBP ; and (5) to identify certain gaps in current knowledge of the role of biobehavioral factors and their application in physical therapy. Give n the central role assumed by many physical therapists in the manageme nt of LBP, acknowledging and addressing these factors in clinical prac tice should assist in the prevention of chronic LBP and disability, as well as potentially improve physical therapy interventions and manage ment. [Feuerstein M, Beattie P. Biobehavioral factors affecting pain a nd disability in low back pain: mechanisms and assessment. Phys Ther. 1995; 75:267-280.]