American Back Society
Factors Associated with Back Pain After Physical Injury A Survey of Consecutive Major Trauma Patients
Ian A. Harris, Jane M. Young, et al
Spine, volume 32, #14, PP 1561-1565, 2007

The purpose of this study was to measure the association between physical and psychological factors, and symptoms of back pain after major physical injury.  The background data summary suggested that a persistence of back pain has been associated more with psychological factors, such as job satisfaction and stress, than with physical factors such as injury characteristics.  Predictors of back pain after major accidental non self-inflicted injury have not previously been reported. 

The authors studied a series of adult patients presenting to a single institution with accidental major trauma over a five-year period and they were followed up between one and six years post injury with a mean of 41 months and a range of 12 to 74 months. The authors found that back pain after major trauma was not associated with measures of injury severity such as the injury Severity Score or the presence of a spinal fracture.  Back pain was also not associated with patient-specific factors, such as age, gender or occupation.  They did observe that back pain was significantly associated with the presence of posttraumatic stress disorder, the use of an attorney, the presence of chronic illness and lower education levels.  They emphasized the importance of psychological factors as predictors of symptomatic back pain after major physical trauma.  They also found that the findings did not support physical factors as important contributors to future low back pain.  The authors site the literature and noting that for back pain to be compensable to Workers Compensation or an injury insurance claim, it must be due to physical injury; however, the injury model of back pain has been challenged.  This challenge is supported by studies of back pain in the workplace, which have shown stronger association with psychological factors (particularly socioeconomic factors, job satisfaction and stress) than with physical factors.  They also note that similar findings have been reported outside the workplace.  The total patients studied were 1156 adult major trauma patients admitted between May 1, 1999 and April 30, 2004.  They noted that almost all the patients involved were either in a motor vehicle accident (63.4%) or a fall from a height (27.3%).

They proceed to state that chronic pain following trauma may be due to the physical injury itself, or it may be related to issues around the injury such as contact with the legal system, blaming others, or secondary gain from such factors as compensation or avoidance of work or home duties.  Although many theories exist regarding possible mechanisms for physical and psychological determinants of back pain, this area remains controversial. Again they conclude that this study highlights the importance of psychological factors in the development of back pain and does not support physical injury factors in the development of persistent low back pain.