The Global Spine Care Initiative: a narrative review of psychological and social issues in back pain in low- and middle-income communities

Eur Spine J. 2018 Sep;27(Suppl 6):828-837. doi: 10.1007/s00586-017-5434-7. Epub 2018 Jan 27.


Purpose: The purpose of this review was to describe psychological and social factors associated with low back pain that could be applied in spine care programs in medically underserved areas and low- and middle-income countries.

Methods: We performed a narrative review of cohort, cross-sectional, qualitative and mixed methods studies investigating adults with low back pain using Medline and PubMed were searched from January 2000 to June 2015. Eligible studies had at least one of the following outcomes: psychological, social, psychosocial, or cultural/ethnicity factors. Studies met the following criteria: (1) English language, (2) published in peer-reviewed journal, (3) adults with spinal disorders, (4) included treatment, symptom management or prevention.

Results: Out of 58 studies, 29 were included in this review. There are few studies that have evaluated psychological and social factors associated with back pain in low- and middle-income communities, therefore, adapting recommendations from other regions may be needed until further studies can be achieved.

Conclusion: Psychological and social factors are important components to addressing low back pain and health care providers play an important role in empowering patients to take control of their spinal health outcomes. Patients should be included in negotiating their spinal treatment and establishing treatment goals through careful listening, reassurance, and information providing by the health care provider. Instruments need to be developed for people with low literacy in medically underserved areas and low- and middle-income countries, especially where psychological and social factors may be difficult to detect and are poorly addressed. These slides can be retrieved under Electronic Supplementary Material.

Keywords: Communication barriers; Physician–patient relations; Psychology; Psychosomatic medicine; Somatosensory disorders; Spine.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Communication
  • Developing Countries
  • Educational Status
  • Global Burden of Disease
  • Humans
  • Job Satisfaction
  • Low Back Pain / etiology*
  • Low Back Pain / psychology*
  • Occupational Diseases / complications
  • Occupational Stress / psychology
  • Patient Education as Topic
  • Professional-Patient Relations
  • Social Determinants of Health
  • Stress, Psychological / psychology