Adaptations Associated with Non-Specific Chronic Low Back Pain: A Narrative Review

Background: Non-specific chronic low back pain (NSCLBP) represents a growing global burden. Individuals with LBP inherently adapt in a variety of ways, across psychological, behavioural and physical domains. However, adaptive changes (e.g., altered lifting behaviour) may persist, becoming maladaptive, resulting in negative functional consequences (i.e., persistence of pain, increased disability). Clinical practice guidelines lack specificity to direct the type of interventions, dosage and treatment duration. A better understanding of how the maladaptive changes seen in people with NSCLBP relate to meaningful outcomes (i.e., disability, function, quality of life) and defined subgroups of people with NSCLBP may inform effective interventions. The aim of this review is to investigate the interrelationship of psychological, behavioural and neuromuscular NSCLBP-related adaptations, and their clinical significance with respect to disability, function, quality of life and pain. Methods and findings: Three MEDLINE searches were conducted to investigate the psychological, behavioural and neuromuscular adaptations in people with NSCLBP. The initial search returned 12972 articles and 238 were identified for full-text review. A total of 93 articles were included in this review. Psychological and behavioural maladaptations (i.e., fear-avoidance beliefs) are associated with poorer patient outcomes, whereas there is uncertainty regarding the impact of maladaptations in the neuromuscular system on important clinical outcomes. Moreover, the evidence is more supportive of the interrelationship between psychological and behavioural maladaptations than any interrelation with neuromuscular maladaptations. To date, methodologies designed to assess NSCLBP-related functional deficits lack ecological validity. Assessment of patients with NSCLBP should focus on psychological and behavioural domains that relate to an individual’s disability and functional impairments. Individuals with NSCLBP present with a variety of diverse adaptions that should focus intervention that aligns patient goals and functional deficits.