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J Pain Res. 2017 Oct 3;10:2373-2385. doi: 10.2147/JPR.S146485. eCollection 2017.

Rehabilitation management of low back pain - it's time to pull it all together!

Author information

School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.
Clinicial Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.
Faculties of Dentistry & Medicine, McGill University, Montreal, QC, Canada.
Duke Health, Department of Orthopaedic Surgery, Duke University Medical Center.
Doctor of Physical Therapy Division, Duke University, Durham, NC, USA.


In the past, rehabilitation research initiatives for low back pain (LBP) have targeted outcome enhancement through personalized treatment approaches, namely through classification systems (CS). Although the use of CS has enhanced outcomes, common management practices have not changed, the prevalence of LBP is still high, and only selected patients meet the CS profile, namely those with a nociceptive context. Similarly, although practice guidelines propose some level of organization and occasionally a timeline of care provision, each mainly provides best practice for isolated treatment approaches. Moreover, there is no theoretical framework that has been proposed that guides the rehabilitation management process of mechanical LBP. In this commentary, we propose a model constituted of five domains (nociceptive drivers, nervous system dysfunction drivers, comorbidities drivers, cognitive-emotional drivers, and contextual drivers) grounded as mechanisms driving pain and/or disability in LBP. Each domain is linked to the International Classification of Functioning, Disability and Health, where once a patient is deemed suitable for rehabilitation, the clinician assesses elements of each domain in order to identify where the relative treatment efforts should be focused. This theoretical model is designed to provide a more comprehensive management overview, by appreciating the relative contribution of each domain driving pain and disability. Considering that the multiple domains driving pain and disability, and their interaction, requires a model that is comprehensive enough to identify and address each related issue, we consider that the proposed model has several positive implications for rehabilitation of this painful and highly prevalent musculoskeletal disorder.


low back pain; pain management; rehabilitation; spine

Conflict of interest statement

Disclosure Yannick Tousignant-Laflamme is a supported member of the Clinical Research Center of the Centre Hospitalier Universitaire de Sherbrooke. Marc Olivier Martel and Yannick Tousignant-Laflamme are both members of the Quebec Pain Research Network (QPRN). The authors report no other conflicts of interest in this work.

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