Welcome back to SpineIQ’s BackBlog! This week in the United States, people will celebrate the life and work of Dr. Martin Luther King Jr. The work of Dr.King and others has helped make the world more equal for all, however, many health inequalities still persist.1,2 Previous research has shown that low back pain outcomes are influenced by the conditions in which people are born, grow, live, work, and age.3 This week to honor Dr. King, we’d like to discuss some of these social determinants that influence low back pain and provide some ideas on how to raise your awareness of these issues and perhaps become involved in your community with efforts to overcome them.
Social determinants influence on low back pain
As health care professionals, we must be aware that there are a lot of influences to low back pain prevalence and outcomes that are beyond the traditional biomedical model and may not be intervened on clinically.4 In fact, a statistic which may surprise you is medical care seems to influence only 20% of health and recovery with social and economic circumstances, environmental factors, and behavioral patterns accounting for 40%, 10%, and 30%, respectively.4,5 Imagine how powerful a combination of evidence-based care for low back coupled with an awareness of social determinants could be. Current research reports increased prevalence of chronic low back pain is associated with low socioeconomic status, unemployment, living in rural areas, and speaking a non-native language. Additionally, research suggests that poor low back pain outcomes are associated with occupations with manual labor jobs, loneliness, low social support, and low socioeconomic status.3,6,7
Addressing social determinants in clinic
In order to begin addressing social determinants with patients, clinicians must be aware of and identify which social factors may be influencing a patient. This begins with asking about social factors during assessment. Additionally, The Social Interventions Research and Evaluation Network (SIREN) has a website with different screening tools that can be used to enquire about social factors more systematically with patients. (https://sirenetwork.ucsf.edu/) However, it is important that clinicians do not start screening for social factors before finding community programs that address those factors. It is ineffective and potentially unethical to screen and find that a patient is experiencing food insecurity without having connections to resources to refer or intervene on it.8 Regardless of where you practice there are some individuals who fall into this category. Clinicians can use this opportunity to partner and collaborate with community organizations that can be a win-win partnership for both sides as many people. An effort by your health care facility working in cooperation with other agencies in your community is a tremendous opportunity for outreach and to enhance the efforts to truly make a difference, even one patient at a time. Another “simple” thing that clinicians can do to help their patients is to make sure that their paperwork is available in multiple languages and at a middle school reading level. Having other clinicians to refer to that are fluent in other languages can be helpful and an opportunity to collaborate as well.
There are many factors outside of clinical care/treatment that influences patients’ health and recovery. Clinicians must be aware of these factors, screen, ask, and prepare to help address them as best as possible. This will help decrease health inequities and decrease low back pain prevalence specifically. This is an area often overlooked and Dr. King’s “Dream” provides each one of us the opportunity to do something in our community to advance that dream.
- Marmot M, Bell R. Social determinants and non-communicable diseases: time for integrated action. BMJ. 2019;364:l251. doi:10.1136/bmj.l251
- Marmot M, Friel S, Bell R, Houweling TAJ, Taylor S, Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet Lond Engl. 2008;372(9650):1661-1669. doi:10.1016/S0140-6736(08)61690-6
- Karran EL, Grant AR, Moseley GL. Low back pain and the social determinants of health: a systematic review and narrative synthesis. Pain. 2020;161(11):2476-2493. doi:10.1097/j.pain.0000000000001944
- Hood CM, Gennuso KP, Swain GR, Catlin BB. County Health Rankings: Relationships Between Determinant Factors and Health Outcomes. Am J Prev Med. 2016;50(2):129-135. doi:10.1016/j.amepre.2015.08.024
- Schroeder SA. Shattuck Lecture. We can do better–improving the health of the American people. N Engl J Med. 2007;357(12):1221-1228. doi:10.1056/NEJMsa073350
- Campbell P, Wynne-Jones G, Dunn KM. The influence of informal social support on risk and prognosis in spinal pain: a systematic review. Eur J Pain Lond Engl. 2011;15(5):444.e1-14. doi:10.1016/j.ejpain.2010.09.011
- Rethorn ZD, Garcia AN, Cook CE, Gottfried ON. Quantifying the collective influence of social determinants of health using conditional and cluster modeling. PLOS ONE. 2020;15(11):e0241868. doi:10.1371/journal.pone.0241868
- Rethorn ZD, Cook C, Reneker JC. Social Determinants of Health: If You Aren’t Measuring Them, You Aren’t Seeing the Big Picture. J Orthop Sports Phys Ther. 2019;49(12):872-874. doi:10.2519/jospt.2019.0613