Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA 01748, USA; University of Massachusetts Medical School, 55 North Lake Avenue, Worcester, MA 01655, USA.
Best Pract Res Clin Rheumatol. 2013 Oct;27(5):637-48. doi: 10.1016/j.berh.2013.09.012. Epub 2013 Oct 5.
Social factors are widely acknowledged in behavioural models of pain and pain management, but incorporating these factors into general medical consultations for low back pain (LBP) can be challenging. While there is no compelling evidence that social factors contribute to LBP onset, these factors have been shown to influence functional limitation and disability, especially the effects of organisational support in the workplace, spousal support, family conflict and social disadvantage. A number of barriers exist to address such social factors in routine medical encounters for LBP, but there is emerging evidence that improving social and organisational support may be an effective strategy to reduce the negative lifestyle consequences of LBP. For clinicians to address these factors in LBP treatment requires a clearer psychosocial framework in assessment and screening, more individualised problem-solving efforts, more patient-centred interventions involving family, peers and workplace supports and a less biomechanical and diagnostic approach.
社会因素在疼痛和疼痛管理的行为模型中得到广泛认可，但将这些因素纳入低背痛（LBP）的一般医疗咨询中可能具有挑战性。虽然没有确凿的证据表明社会因素导致 LBP 发作，但这些因素已被证明会影响功能受限和残疾，特别是工作场所中的组织支持、配偶支持、家庭冲突和社会劣势的影响。在 LBP 的常规医疗就诊中，存在许多解决这些社会因素的障碍，但有新的证据表明，改善社会和组织支持可能是减少 LBP 对生活方式负面影响的有效策略。为了让临床医生在 LBP 治疗中解决这些因素，需要在评估和筛查中使用更清晰的心理社会框架，进行更多个性化的解决问题的努力，采取更多以患者为中心的干预措施，包括家庭、同龄人、工作场所的支持，以及减少生物力学和诊断方法。
