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Subgrouping of Low Back Pain Patients for Targeting Treatments: Evidence from Genetic, Psychological, and Activity-related Behavioral Approaches

Huijnen, Ivan P.J. PhD*,†,‡; Rusu, Adina C. PhD§,∥; Scholich, Sarah MSc§; Meloto, Carolina Beraldo PhD; Diatchenko, Luda PhD, MD

doi: 10.1097/AJP.0000000000000100
Special Topic Series

Introduction: Many patients with low back pain (LBP) are treated in a similar manner as if they were a homogenous group. However, scientific evidence is available that pain is a complex perceptual experience influenced by a wide range of genetic, psychological, and activity-related factors. The leading question for clinical practice should be what works for whom.

Objectives: The main aim of the present review is to discuss the current state of evidence of subgrouping based on genetic, psychosocial, and activity-related factors in order to understand their contribution to individual differences.

Results: Based on these perspectives, it is important to identify patients based on their specific characteristics. For genetics, very promising results are available from other chronic musculoskeletal pain conditions. However, more research is warranted in LBP. With regard to subgroups based on psychosocial factors, the results underpin the importance of matching patients’ characteristics to treatment. Combining this psychosocial profile with the activity-related behavioral style may be of added value in tailoring the patient’s treatment to his/her specific needs.

Conclusions: For future research and treatment it might be challenging to develop theoretical frameworks combining different subgrouping classifications. On the basis of this framework, tailoring treatments more specifically to the patient needs may result in improvements in treatment programs for patients with LBP.

*Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University

Academic Hospital Maastricht, Department of Rehabilitation Medicine, Maastricht

Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands

§Department of Medical Psychology and Medical Sociology, Ruhr-University of Bochum, Bochum, Germany

Department of Psychology, Royal Holloway, University of London, London, UK

The Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada

Huijnen and Rusu shared first authorship.

The work of A.C.R. for this manuscript has been partially supported by a grant from the Research Committee of the University of Bochum, Bochum, Germany. The authors declare no conflict of interest.

Reprints: Ivan P.J. Huijnen, PhD, Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, P.O. Box 616, Maastricht 6200 MD, The Netherlands (e-mail:

Received February 28, 2014

Received in revised form March 11, 2014

Accepted March 10, 2014

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