What Biopsychosocial Factors Increase Back Pain Risk?

31st Annual Meeting of the North American Spine Society Highlight

Back pain causes numerous problems in the United States—from reducing quality of life to contributing to skyrocketing health care costs. Identifying people who are at the highest risk of developing back pain may open doors to research into targeted prevention strategies to reduce these societal burdens. Bart Green, DC, MS, PhD shared what biopsychosocial factors, such as depression, anxiety, and smoking status, are the strongest predictors of back pain during the 31st Annual Meeting of the North American Spine Society on October 26-29, 2016, in Boston.
Man smoking and depressedRecognizing certain groups as having a higher risk for back pain is a challenge for the health care community, as the current literature on this topic has been inconclusive. By understanding whether biopsychosocial factors can foreshadow future back pain problems in patients, providers may be able to develop more prevention-minded care plans for these patients, according to Dr. Green and his research colleagues.

“It might help us better identify people at a higher risk of back pain who may need other interventions that should be geared toward psychosocial interventions more so than physical ones,” Dr. Green said.

Casting a Wide Net to Gain a Broader Perspective
The goal of Dr. Green and his research team was to look at back pain from a broader perspective by examining a large, nationally representative data set. The team analyzed the 2012 National Health Interview Survey (NHIS), which included data on 34,525 American adults.

“This is across a sample of the U.S. population, so we weren’t just people coming into certain clinics to have certain procedures done,” Dr. Green said. “We were looking across a large and wide group of people.”

The dependent variable was simply whether the subject had back pain at least once the previous three months. Twenty-nine percent of the total survey respondents reported the presence of back pain. The average subject was 46 years old and had a BMI in the overweight range. Most respondents were female (55.8%) and non-Hispanic white (60.4%). On average, the sample completed high school but did not earn a college degree, and they did not meet the physical activity recommendations of 150 minutes a week.

The research team analyzed nine independent variables to determine which, if any, significantly raised a person’s risk for developing back pain. The variables were broken into three categories: biological, psychological, and social.

Biological independent variables:

  • Age
  • Sex
  • Body mass index (BMI)
  • Race

Psychological independent variables:

  • Depression (defined as having been diagnosed with depression in the prior year)
  • Anxiety (the subjects would report if they felt excessively anxious, nervous, or worried in the previous three months)
  • Smoking status (current smoker, former smoker, or never smoker)

Social independent variables:

  • Education level
  • Physical activity level

Dr. Green and his colleagues analyzed the data at a population level and accounted for specific sampling methods in the NHIS survey by performing a direct multiple logistic regression in SPSS 21 Complex Samples Analysis.

Anxiety, Depression, Smoking, and Obesity Pose Biggest Back Pain Risk
Out of the nine independent variables analyzed, four emerged as having the greatest odds of being associated with back pain: anxiety, depression, smoking status, and obesity (BMI).

“What we found was that people who said they had anxiety were almost three times as likely to have back pain as people who said they didn’t,” Dr. Green said. Anxiousness was reported by 19.2% of respondents.

Similarly, depression was reported by 14.1% of respondents and was associated with nearly double the back pain risk compared to those who did not report depression. Current smokers were nearly twice as likely to have back pain than non-smokers or never smokers, though former smokers still had an increased risk of developing back pain compared to their never smoker counterparts. 

In addition to anxiety, depression, smoking status, and obesity, those not meeting the American Heart Association’s guidelines of 150 minutes a week of exercise also had a significant risk of developing back pain.

By understanding how certain biopsychosocial influences affect a person’s back pain risk—particularly anxiety, depression, smoking, and obesity—clinicians may be able to cater interventions from a more preventive mindset and improve their patients’ long-term quality of life.

Bart Green, DC, MS, PhD’s financial disclosures: Consultant for Brighthall; speaking and/or teaching arrangements with NCMIC; and, trips/travel with NCMIC. 

To view additional meeting highlights from the 31st Annual Meeting of NASS, click here.

Updated on: 10/26/17
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