Can emotional distress induce acute low back pain? A systematic review

INTRODUCTION:
Low back pain (LBP) is a leading cause of disability worldwide. A spectrum of psychological conditions such as anxiety, fear, stress and low mood are often reported to co-occur in individuals with persistent back pain and are cited as reasons for the continued experience of pain. However, any potential causal effect of emotional distress on new onset LBP is understudied. Therefore, the aim of this review is to examine the impact of emotional distress as a risk factor for new presentations of acute low back pain.

METHODS:
A systematic review was performed in accordance with the PRISMA guidelines. The Medline, Embase and APA databases were searched for primary research articles exploring emotional distress and low back pain. Prospective studies that investigated subjects initially free from back pain, who also undertook some form of psychometric testing at baseline, were included in the review. In total, 6 studies were identified with a broad geographical spread and diverse population cohorts including pregnant women, forestry workers, nursing students, adolescents, individuals with medical comorbidities and adult population studies.

RESULTS:
The results from all six studies found a significant relationship between an initial presence of emotional distress and subsequent onset of acute low back pain.

CONCLUSION:
This review encourages the acknowledgement of underlying emotional distress as a risk factor in acute low back pain, and to address it as part of the overall management plan.