Musculoskeletal lower back pain

Many patients have to take time off work during an episode of acute lower back pain. The longer the period of absence (e.g., 6 months or more), the less likely they are to return to work. This has huge psychosocial and economic implications.[183]Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646-56. http://www.ncbi.nlm.nih.gov/pubmed/14710506?tool=bestpractice.com

Psychiatric comorbidities such as depression, anxiety, and somatisation increase the risk of progression to chronic disabling pain.[62]Pincus T, Burton AK, Vogel S, et al. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine. 2002 Mar 1;27(5):E109-20. http://www.ncbi.nlm.nih.gov/pubmed/11880847?tool=bestpractice.com Psychosocial risk factors for progressing to chronic low back pain are wide-ranging.[34]Chou R, Shekelle P. Will this patient develop persistent disabling low back pain? JAMA. 2010 Apr 7;303(13):1295-302. http://www.ncbi.nlm.nih.gov/pubmed/20371789?tool=bestpractice.com [184]Ramond-Roquin A, Bouton C, Gobin-Tempereau AS, et al. Interventions focusing on psychosocial risk factors for patients with non-chronic low back pain in primary care - a systematic review. Fam Pract. 2014 Aug;31(4):379-88. http://fampra.oxfordjournals.org/content/31/4/379.long http://www.ncbi.nlm.nih.gov/pubmed/24632524?tool=bestpractice.com

Available evidence suggests that the clinician should consider consulting psychiatry if mood or anxiety disorders are suspected.

Depression in adults