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Psychosocial factors in low back pain: letting go of our misconceptions can help management
  1. Mary O’Keeffe1,2,
  2. Steven Z George3,
  3. Peter B O’Sullivan4,5,
  4. Kieran O’Sullivan6,7
  1. 1 Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  2. 2 Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
  3. 3 Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
  4. 4 Health Sciences Division, School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
  5. 5 Body Logic Physiotherapy, Perth, Western Australia, Australia
  6. 6 Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  7. 7 School of Allied Health, University of Limerick, Limerick, Ireland
  1. Correspondence to Dr. Mary O’Keeffe, Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, NSW 2050, Australia; mary.okeeffe{at}

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The Lancet low back pain (LBP) series1 highlighted the important role of psychosocial factors in LBP and its associated disability. It is worth reflecting on what psychosocial factors are, and are not, in order to optimise management.

Psychosocial factors are not always mental health disorders

Not all psychosocial factors are indicative of a mental health disorder which requires assessment and treatment by a dedicated mental health provider. For example, fear of movement is NOT necessarily a mental health disorder unless the individual meets the criteria for phobic disorder. While we need to competently identify patients with comorbid mental health disorders, such cases are the exception, not the rule. As such, many psychosocial factors (eg, fear of movement, distress about scan findings, depression related to a loss of valued activities, anxiety about the future, social stress) can be within the scope of musculoskeletal clinicians.

We contend that the way we have categorised interventions for LBP into ‘physical’ or ‘psychological’ has created boundaries for what clinicians deem to be within their scope.2 We …

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  • Contributors All authors contributed equally to the design and writing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests KOS serves in a voluntary capacity as Senior Associate Editor of BJSM.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.