• Anthony Chau, Sharis Steib, Evans Whitaker, David Kohns, Alexander Quinter, Anita Craig, Anthony Chiodo, SriKrishan Chandran, Ann Laidlaw, Zachary Schott, Nathan Farlow, John Yarjanian, Ashley Omwanghe, Ronald Wasserman, Conor O'Neill, Dan Clauw, Anton Bowden, William Marras, Tim Carey, Wolf Mehling, C Anthony Hunt, and Jeffrey Lotz.
• Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, USA.
• Pain Med. 2023 Aug 4; 24 (Suppl 1): S13S35S13-S35.

BackgroundChronic low back pain (cLBP) is a complex with a heterogenous clinical presentation. A better understanding of the factors that contribute to cLBP is needed for accurate diagnosis, optimal treatment, and identification of mechanistic targets for new therapies. The Back Pain Consortium (BACPAC) Research Program provides a unique opportunity in this regard, as it will generate large clinical datasets, including a diverse set of harmonized measurements. The Theoretical Model Working Group was established to guide BACPAC research and to organize new knowledge within a mechanistic framework. This article summarizes the initial work of the Theoretical Model Working Group. It includes a three-stage integration of expert opinion and an umbrella literature review of factors that affect cLBP severity and chronicity.MethodsDuring Stage 1, experts from across BACPAC established a taxonomy for risk and prognostic factors (RPFs) and preliminary graphical depictions. During Stage 2, a separate team conducted a literature review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to establish working definitions, associated data elements, and overall strength of evidence for identified RPFs. These were subsequently integrated with expert opinion during Stage 3.ResultsThe majority (∼80%) of RPFs had little strength-of-evidence confidence, whereas seven factors had substantial confidence for either a positive association with cLBP (pain-related anxiety, serum C-reactive protein, diabetes, and anticipatory/compensatory postural adjustments) or no association with cLBP (serum interleukin 1-beta / interleukin 6, transversus muscle morphology/activity, and quantitative sensory testing).ConclusionThis theoretical perspective will evolve over time as BACPAC investigators link empirical results to theory, challenge current ideas of the biopsychosocial model, and use a systems approach to develop tools and algorithms that disentangle the dynamic interactions among cLBP factors.© The Author(s) 2022. Published by Oxford University Press on behalf of the American Academy of Pain Medicine.

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