Thread by @belavyprof

What causes back pain?🤔
Specifically: how much do nervous system, spine tissue and psychosocial contribute to #backpain?

#systematicreview with multivariate #metaanalysis in European J Pain @EFIC_org

doi.org/10.1002/ejp.18…

Led by @ScottTags 🙏collaborators

Thread
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Low #backpain is leading cause of disability worldwide… 90-95% of cases are considered 'non-specific'

Many factors can contribute

Image 👇from doi.org/10.2147/jpr.s1… @chadcookpt

But which ones and how much?

Individual meta-analyses + factors associated with back pain
➡️ pain processing doi.org/10.1097/j.pain…
➡️ disc degeneration doi.org/10.3174/ajnr.A…
➡️ muscle atrophy doi.org/10.2522/ptj.20…
➡️ depression / distress doi.org/10.1093/fampra…

But is one more important than other?

Methods:
 #systematicreview multivariate #metaanalysis
 studies comparing non-specific #backpain to pain-free
 studies MUST have at least two of three domains (Table👇)
 Newcastle-Ottawa scale for risk of bias
 random-effects pairwise and multivariate meta-analyses

Results
> 4000 studies screened
52 studies included
33 in quantitative synthesis

4 (12%) studies examined spinal imaging
33 (100%) psychosocial factors
30 (91%) nervous system biomarkers

>2000 participants in primary meta-analyses

Results:
✅Psychosocial factors had largest effect size
✅Larger than spine tissue or central nervous system biomarkers

Results:
✅chronic pain: nervous system, psychosocial and spinal imaging were different compared to pain-free control
✅acute pain: only psychosocial state was compromised. Spinal imaging biomarkers could not be assessed due to the lack of studies

Results:

✅looking at all the different kinds of biomarkers lumped in under (for example) nervous system, lead to similar results

What do the findings mean?

Spinal imaging, psychosocial and nervous system biomarkers contribute to non-specific low #backpain

Psychosocial factors "may" contribute more to non-specific back pain (note, we talk only about "effect sizes")

Paths forward in the future… some key aspects:

➡️ Only one (!) study to date that assessed all three domains. This = big evidence gap

➡️ The ‘non-specific’ label should be reconsidered as research finds specific and treatable multidimensional labels underpinning the condition

Limitations include:

(a) Only cross-sectional studies available (causality)

(b) Only four studies assessed the role of the spinal imaging along with psychosocial/nervous system biomarkers.. need more studies for this

(c) The lack of consistent reporting of brain regions

Key next steps:

🚀Larger scale study examining multiple domains

🚀Then, consideration of multidimensional sub-groups and their potential clinical significance

Maybe, one day, we can do away with the label non-specific for back pain 🙂

Interested in the research group @hsgesundheit in musculoskeletal health research in #Germany?

More details here and link to team website
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https://twitter.com/belavyprof/status/1380419859549462528