Top 25 Variables That Contribute to Slow Healing of Low Back Pain

It is very common to feel like your healing process is going way too slow. The frustration is understandable, but so is keeping a level head, objectivity and reasonable expectations. Without maintaining these, we set ourselves up for frustration, disappointment, selling ourselves short, and streamlining drugs and surgery.  Patience and a clear head lead to identifying “perpetuation factors” of what we are suffering with, which prompts change in daily life if we are conscious enough to see what we are doing and acknowledge the need for change. If you are going to be frustrated, discouraged, disappointed, do it after you have done everything right.

A wide range of factors can contribute to the slow healing of low back pain, influencing the risk of pain becoming chronic and recovery being delayed. These factors span physical, psychological, social, and lifestyle domains. Based on the evidence from systematic reviews and authoritative sources, the following are the top 25 variables most commonly associated with slower healing in low back pain. Use this as a partial checklist for your own contributing factors to slow healing, then assess, and make changes to that which you can. Needless to say, you can’t change your age, but you can acknowledge the wear and tear over the years that may be making your recovery slower. This understanding reduces stress and helps to manage expectations:

Physical and Biological Factors

  • Higher pain intensity at onset 1 2
  • Higher body weight/obesity 1 3 4
  • Older age 1 2
  • Female sex 1
  • Poor general health or multimorbidity 1
  • Functional limitation/disability during the episode 1 2
  • Low pain threshold/low tolerance for pain 1
  • Arthritis or degenerative changes in the spine 3
  • Previous episodes of low back pain 2
  • Longer duration of symptoms before seeking care 2

Occupational and Activity-Related Factors

  • Carrying heavy loads at work 1
  • Difficult or awkward working positions1
  • High physical stress or strenuous physical work 1 4
  • Exposure to vibrations or jolts at work 1
  • Sedentary lifestyle (low physical activity) 3 4
  • Behavioral overactivity (persisting with activities despite severe pain)5

Lifestyle Factors

  • Smoking 1 3 4
  • Lack of regular physical exercise 1 3 4

Psychological and Psychosocial Factors

  • Depression 1 2 5
  • General anxiety 1
  • Fear-avoidance beliefs (avoiding activity due to fear of pain) 1 5
  • Pain catastrophizing (exaggerated negative mental set about pain) 1 5
  • Maladaptive coping strategies (e.g., ignoring pain, somatization) 1 5
  • Patients’ perceived risk of symptom persistence 1 2
  • High psychological job demands 1
  • Low self-efficacy (low confidence in ability to manage pain) 5
  • Low social support at work or home 1

Additional Factors