Investigation of the relevant factors in the complexity of chronic low back pain patients with a physiotherapy prescription. A network analysis approach, comparing chronic-pain free individuals and chronic patients

Objective: Chronic Low Back Pain (CLBP) is the leading cause of disability worldwide, and several factors have been proposed as potential causes or co-factors. We aimed to explore their direct and indirect relations to understand CLBP and identify relevant rehabilitation targets. Methods: 119 CLBP patients and 117 chronic-pain free individuals were assessed. A network analysis approach was employed to explore the complexity of CLBP by assessing the relations between pain intensity, disability, functionality (physical, social and psychological), age, body mass index, and education level. Results: The network analysis revealed the independence of pain and disability related to CLBP from age, sex, and BMI. Crucially, pain intensity and disability are directly and strongly connected in chronic-pain free individuals, but not in CLBP patients. Psychosocial functioning is related to pain intensity and disability indirectly through the mediation of one's general health perception and perceived physical functionality. Conclusion: Clinicians should pay more attention to perceived physical functionality and psychosocial factors as they are tightly linked to CLBP. Indeed, pain intensity seems a sub-optimal rehabilitation target. Our study suggests that a biopsychosocial approach is much needed to investigate CLBP, but it also warns against overestimating the direct impact of each potential contributor.