A Long or short game? Psychosocial predictors of chronic low back pain 

Summary: Psychosocial factors are known to be important in the development of low back pain. This 2020 study analysed the predictive value of specific types of psychosocial stress and self efficacy in development of chronic low back pain. It is relevant for Osteopaths to understand the possible influence of particular types of psychosocial stress such as work or social stress, and self-efficacy on “chronification” of low back pain since they may need to be addressed differentially in the treatment plan.


Keywords: Psychosocial stress; Low back pain; Chronic pain; Self Efficacy

The link between stress and chronic low back pain is indisputable. In this 2020 study, from Journal of Pain  Research, psychosocial stressors and self-efficacy were assessed as predictors for the development of chronic low back pain over 2 years.

Particular types of stress (eg social or lack-of-control factors), repeated stressful events or long-lasting stressful  situations can lead to an over-activated stress response.  Not only does this result in depleted energy, poor repair and general wear and tear of body resources (“allostatic load”) but ultimately may result in dysfunctional reactions to acute stressors: depression, fatigue, increased pain. These are all familiar in a chronic pain patient presentation. 

Self efficacy is a “person’s belief to be able to deal with upcoming challenges”. It is associated with putting more effort into achieving goals and feeling more capable, all relevant for those in pain. It is regarded as one of the most important psychological protective factors for prevention of chronic pain, or reduced disability in those with chronic pain.

The study method was a prospective observational study over 2 years of 1071 subjects with low back pain at baseline. Psychosocial stress factors (perceived stress, work stress experiences, social stress experiences, vital exhaustion/stress fatigue, life event stress) and self efficacy were assessed using 5 questionnaires and regression analysis was used to identify specific predictors of pain intensity and pain-related disability at 1 year and 2 years.

A tendency to worry and social isolation predicted both back pain and disability 1 and 2 years later. Prior stressful life events, vital exhaustion and work discontent also predicted pain and/or disability 1 year later, and social conflicts, lack of recognition at work, work discontent and perceived stress predicted pain and/or disability 2 years later. Self efficacy showed a predictive effect for having back pain that was stronger for 2 years later than 1 year later.   

The study admits moderate prediction errors so the factors above provide some predictive value but do not reflect the whole story.  This is no surprise, back pain is very complex with multiple interactions so encapsulating some sort of linear predictive model or finding a predominant predictor is unrealistic.  The role of other factors such as depression, pain related beliefs and other yellow flags must also be considered. However, it is useful for Osteopaths to recognise different psychosocial stressors and promote self efficacy in order to moderate potential drivers and protectors for chronic low back pain.  This is relevant both for treating patients with chronic low back pain, and preventing low back pain from becoming chronic. Notably, stressors tendency to worry, social isolation and others are particularly  relevant in the current pandemic, for which undoubtedly patients  in osteopathic clinic will be experiencing additional psychosocial stress load. Osteopaths should be vigilant to this and address them appropriately in the treatment plan. 


Puschmann A-K, Drießlein D, Beck H, Arampatzis A, Catala AM, Schiltenwolf M, Mayer F, Wippert P-M. Stress and Self-Efficacy as Long0Term Predictors for Chronic low Back Pain: A Prospective Longitudinal Study. Journal  of Pain Research 2020:13 613-621



Hazel Mansfield

June 2021

Hazel is an Osteopath of 15 years’ experience with a background in neuropsychology, and a renowned lecturer of osteopaths and other manual therapists at both undergraduate and post-graduate levels. 

Hazel studied Natural Sciences at Cambridge University, specialising in neuropsychology before training as an osteopath at the British College of Osteopathy in London.

She consults in private practice in Stockholm, with a special interest in back pain, stress, and using the best available knowledge to elevate standards of patient care.