Abstract
PURPOSE: Pain-related disability is often managed using the biopsychosocial model. However, social factors, such as living situation, financial hardship and employment status, are understudied. This study focused on the association between social factors and pain-related disability after correcting for important biological factors (e.g. BMI) and psychological factors (e.g. depression) in people with spinal pain. METHODS: Cross-sectional data were used from the fourth wave (N = 4,007) of the second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2), a representative cohort study in the general population of The Netherlands. Data from adults between 27-73 years of age with spinal pain (N = 1,451) were extracted. Data were analysed using multivariable linear regression analyses and results are expressed in (standardized) beta coefficients. RESULTS: Loneliness (β = 0.06; p = 0.01) and financial hardship (β = 0.04; p = 0.04) were significantly associated with pain-related disability after correction for biological and psychological factors. Educational background and employment status were the significant effect modifiers for the association of pain intensity and pain-related disability. DISCUSSION: The social dimension acts as an independent component influencing pain-related disability, establishing itself as an important domain within the biopsychosocial model meriting deeper exploration. Clinicians and researchers should explore these social factors more in people with spinal pain in management and research.