Managing Chronic Low Back Pain: A Physiotherapist’s Multifactorial Approach

Chronic low back pain (defined as pain lasting longer than 12 weeks) is the leading cause of disability worldwide. It is a condition involving multiple contributors, including: psychological, social, biological and lifestyle factors. These factors are known to feed into each other and increase an individual’s sensitivity to pain.

Evidence shows the importance of using what is known as a “biopsychosocial framework,” where physiotherapists address the biological, psychological and social factors that may be causing low back pain. Incorporating this multifactorial approach and identifying external contributors, allows for more effective treatment

Helping an individual understand the science behind how pain works can assist them in feeling more empowered and in control of their pain. Realising why their pain is occurring can also challenge previously held negative beliefs.

As an example, many believe: “Each time I feel pain I am doing more damage.” This is likely not the case! Debunking this belief can help change a person’s attitude towards their pain. So, empowering them in understanding their pain, allows them to manage it more effectively.

Additionally, managing stressors in an individual’s life as well as addressing other lifestyle factors such as exercise, diet, and daily activities, can all help in managing chronic pain.

There is limited evidence that suggest strategies such as mindfulness and meditation improve pain levels in individuals living with chronic pain. However, incorporating this method may assist in decreasing stress, anxiety or depression, which may be linked to increased sensitivity to pain.

Of course, exercises for muscle strengthening are also an important factor in managing lower back pain. Evidence suggests that a physiotherapy-led exercise program that is tailored to an individual’s specific circumstances is more effective that a general exercise program.

When physiotherapists consider the multiple aspects that may be contributing to someone’s pain, they are better equipped to manage it. Empowering someone to understand their pain, completing a program tailored to their needs, as well as assisting them to manage lifestyle factors, all contribute to better outcomes in reducing chronic lower back pain.   

Anna Dowling