7 Psychosocial issues in the prevention of chronic low back pain a literature review S. WEISER C. CEDRASCHI Studies of chronic low back pain have given ample consideration to psycho- social factors (for a review see Joukamaa, 1987). Deleterious social and emotional aspects of chronic pain have been eloquently described by many experts in the field (Sternbach, 1978; Waddell, 1987a; Fordyce, 1988). Numerous studies confirm the clinical impression that chronic pain patients suffer from psychological distress and social isolation. Nonetheless, the role of these factors as predictors, correlates or outcomes of illness remains unclear. The importance of these relationships becomes particularly cogent when the objective is to prevent chronicity and disability through the identi- fication of those at risk. Psychological and social factors play a greater role in the maintenance of illness as pain moves from the acute to the chronic stages. Acute pain is determined mainly by nociception and to a lesser extent, the psychosocial constitution of the individual. In chronic pain, the order is reversed. Nociception becomes less of a determinant of functional status then psycho- logical and social attributes (Spengler et al, 1980; Waddell, 1987b). Theo- retical models that describe the psychosocial processes by which pain becomes chronic have been formulated and well received (Sternbach, 1978; Waddell, 1987b; Fordyce, 1988; Waddell, Chapter 1). However, few studies have tested these theories. This chapter reviews studies of psychosocial factors associated with the development and prevention of chronic pain. It is organized into three sections. The first section discusses studies that identify psychological and social attributes of healthy or recent low back pain sufferers that may predict outcome. Some of the problems inherent in this type of research are discussed. The next section reviews low back pain prevention programmes that are based fully or partially on psychosocial strategies. The success of these interventions is assessed. Finally, issues of concern in the assessment and treatment of acute patients are presented and discussed. It is our hope that this information will be useful to researchers and clinicians who champion the cause of preventing chronic low back pain. Bailli~re' s Clinical Rheumatology-- 657 Vol. 6, No. 3, October1992 Copyright 91992, byBailli~re Tindall ISBN0-7020-1637-3 All rightsofreproduction in anyform reserved