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Twenty-Five Years With the Biopsychosocial Model of Low Back Pain—Is It Time to Celebrate? A Report From the Twelfth International Forum for Primary Care Research on Low Back Pain

Pincus, Tamar PhD*; Kent, Peter PhD; Bronfort, Gert PhD‡,§; Loisel, Patrick PhD¶,‖; Pransky, Glenn MD, MoccH**,††,‡‡; Hartvigsen, Jan PhD§,§§

doi: 10.1097/BRS.0b013e3182a8c5d6
Health Services Research

Study Design. An integrated review of current knowledge about the biopsychosocial model of back pain for understanding etiology, prognosis, and interventions, as presented at the plenary sessions of the XII International Forum on LBP Research in Primary Care (Denmark; October 17–19, 2012).

Objective. To evaluate the utility of the model in reference to rising rates of back pain-related disability, by identifying (a) the most promising avenues for future research in biological, psychological, and social approaches, (b) promising combinations of all 3 approaches, and (c) obstacles to effective implementation of biopsychosocial-based research and clinical practice.

Summary of Background Data. The biopsychosocial model of back pain has become a dominant model in the conceptualization of the etiology and prognosis of back pain, and has led to the development and testing of many interventions. Despite this back pain remains a leading source of disability worldwide.

Methods. The review is a synthesis based on the plenary sessions and discussions at the XII International Forum on LBP Research in Primary Care. The presentations included evidence-based reviews of the current state of knowledge in each of the 3 areas (biological, psychological, and social), identification of obstacles to effective implementation and missed opportunities, and identification of the most promising paths for future research.

Results. Although there is good evidence for the role of biological, psychological, and social factors in the etiology and prognosis of back pain, synthesis of the 3 in research and clinical practice has been suboptimal.

Conclusion. The utility of the biopsychosocial framework cannot be fully assessed until we truly adopt and apply it in research and clinical practice.

Level of Evidence: N/A

Twenty-five years after Gordon Waddell published a seminal article on the biopsychosocial model, back pain remains a worldwide health challenge. Whether this is a result of problems in the model or its understanding and application was explored at the International Forum for Primary Care Research on Low Back Pain.

*Department of Psychology, Clinical, Health, and Social Psychology, Royal Holloway, University of London, England, United Kingdom

Research Department, Spine Centre of Southern Denmark, Institute of Regional Health Services Research, Hospital Lillebaelt, University of Southern Denmark, Middelfart, Denmark

Musculoskeletal Research Program, Northwestern Health Sciences University, Minnesota

§Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark

Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

Canadian Memorial Chiropractic College, Toronto, Ontario, Canada

**Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts

††Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA

‡‡Harvard School of Public Health, Boston, MA; and

§§Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.

Address correspondence and reprint requests to Tamar Pincus, PhD, Department of Psychology, Clinical, Health and Social Psychology, Royal Holloway, University of London, England, United Kingdom; E-mail:

Acknowledgment date: May 6, 2013. First revision date: July 16, 2013. Acceptance date: August 9, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy and grants/grants pending.

© 2013 by Lippincott Williams & Wilkins