TY - JOUR
T1 - Relative contributions of the nervous system, spinal tissue and psychosocial health to non-specific low back pain
T2 - Multivariate meta-analysis
AU - Tagliaferri, Scott D.
AU - Ng, Sin Ki
AU - Fitzgibbon, Bernadette M.
AU - Owen, Patrick J.
AU - Miller, Clint T.
AU - Bowe, Steven J.
AU - Belavy, Daniel L.
N1 - Funding Information:
Scott Tagliaferri is supported by an Australian Government Research Training Program (RTP) Scholarship. No other funding was received for this research.
Publisher Copyright:
© 2021 European Pain Federation - EFIC®.
PY - 2022/3
Y1 - 2022/3
N2 - Background and Objectives: Nervous system, psychosocial and spinal tissue biomarkers are associated with non-specific low back pain (nsLBP), though relative contributions are unclear. Databases and Data Treatment: MEDLINE, EMBASE, CINAHL, PsycINFO and SPORTDiscus were searched up to 25 March 2020. Related reviews and reference lists were also screened. Observational studies examining structural and functional nervous system biomarkers (e.g. quantitative sensory tests, structural and functional brain measures), psychosocial factors (e.g. mental health, catastrophizing) and structural spinal imaging biomarkers (e.g. intervertebral disc degeneration, paraspinal muscle size) between nsLBP and pain-free controls were included. For multivariate meta-analysis, two of three domains were required in each study. Random-effects pairwise and multivariate meta-analyses were performed. GRADE approach assessed evidence certainty. Newcastle-Ottawa scale assessed risk of bias. Main outcomes were the effect size difference of domains between nsLBP and pain-free controls. Results: Of 4519 unique records identified, 33 studies (LBP = 1552, referents = 1322) were meta-analysed. Psychosocial state (Hedges’ g [95%CI]: 0.90 [0.69–1.10], p < 0.001) in nsLBP showed larger effect sizes than nervous system (0.31 [0.13–0.49], p < 0.001; difference: 0.61 [0.36–0.86], p < 0.001) and spine imaging biomarkers (0.55 [0.37–0.73], p < 0.001; difference: 0.36 [0.04–0.67], p = 0.027). The relationship between domains changes depending on if pain duration is acute or chronic. Conclusions: Psychosocial effect sizes in nsLBP are greater than that for spinal imaging and nervous system biomarkers. Limitations include cross-sectional design of studies included and inference of causality. Future research should investigate the clinical relevance of these effect size differences in relation to pain intensity and disability. Study Registration: PROSPERO-CRD42020159188. Significance: Spinal imaging (e.g. intervertebral disc degeneration), psychosocial (e.g. depression) and nervous system (e.g. quantitative sensory tests, structural and functional brain measures) biomarkers contribute to non-specific low back pain. However, psychosocial factors may be more compromised than nervous system and spinal imaging biomarkers. This relationship depends on if the pain is acute or chronic. These findings underscore that the ‘non-specific’ label in back pain should be reconsidered, and more specific multidimensional categories evaluated to guide patient management.
AB - Background and Objectives: Nervous system, psychosocial and spinal tissue biomarkers are associated with non-specific low back pain (nsLBP), though relative contributions are unclear. Databases and Data Treatment: MEDLINE, EMBASE, CINAHL, PsycINFO and SPORTDiscus were searched up to 25 March 2020. Related reviews and reference lists were also screened. Observational studies examining structural and functional nervous system biomarkers (e.g. quantitative sensory tests, structural and functional brain measures), psychosocial factors (e.g. mental health, catastrophizing) and structural spinal imaging biomarkers (e.g. intervertebral disc degeneration, paraspinal muscle size) between nsLBP and pain-free controls were included. For multivariate meta-analysis, two of three domains were required in each study. Random-effects pairwise and multivariate meta-analyses were performed. GRADE approach assessed evidence certainty. Newcastle-Ottawa scale assessed risk of bias. Main outcomes were the effect size difference of domains between nsLBP and pain-free controls. Results: Of 4519 unique records identified, 33 studies (LBP = 1552, referents = 1322) were meta-analysed. Psychosocial state (Hedges’ g [95%CI]: 0.90 [0.69–1.10], p < 0.001) in nsLBP showed larger effect sizes than nervous system (0.31 [0.13–0.49], p < 0.001; difference: 0.61 [0.36–0.86], p < 0.001) and spine imaging biomarkers (0.55 [0.37–0.73], p < 0.001; difference: 0.36 [0.04–0.67], p = 0.027). The relationship between domains changes depending on if pain duration is acute or chronic. Conclusions: Psychosocial effect sizes in nsLBP are greater than that for spinal imaging and nervous system biomarkers. Limitations include cross-sectional design of studies included and inference of causality. Future research should investigate the clinical relevance of these effect size differences in relation to pain intensity and disability. Study Registration: PROSPERO-CRD42020159188. Significance: Spinal imaging (e.g. intervertebral disc degeneration), psychosocial (e.g. depression) and nervous system (e.g. quantitative sensory tests, structural and functional brain measures) biomarkers contribute to non-specific low back pain. However, psychosocial factors may be more compromised than nervous system and spinal imaging biomarkers. This relationship depends on if the pain is acute or chronic. These findings underscore that the ‘non-specific’ label in back pain should be reconsidered, and more specific multidimensional categories evaluated to guide patient management.
UR - http://www.scopus.com/inward/record.url?scp=85119302388&partnerID=8YFLogxK
U2 - 10.1002/ejp.1883
DO - 10.1002/ejp.1883
M3 - Review Article
C2 - 34748265
AN - SCOPUS:85119302388
SN - 1090-3801
VL - 26
SP - 578
EP - 599
JO - European Journal of Pain
JF - European Journal of Pain
IS - 3
ER -