{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T08:59:02Z","timestamp":1793091542109,"version":"4.5.0"},"reference-count":125,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,11,14]],"date-time":"2021-11-14T00:00:00Z","timestamp":1636848000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Objectives<\/jats:title><jats:p>Nervous system, psychosocial and spinal tissue biomarkers are associated with non\u2010specific low back pain (nsLBP), though relative contributions are unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Databases and Data Treatment<\/jats:title><jats:p>MEDLINE, EMBASE, CINAHL, PsycINFO and SPORTDiscus were searched up to 25 March 2020. Related reviews and reference lists were also screened. Observational studies examining structural and functional nervous system biomarkers (e.g. quantitative sensory tests, structural and functional brain measures), psychosocial factors (e.g. mental health, catastrophizing) and structural spinal imaging biomarkers (e.g. intervertebral disc degeneration, paraspinal muscle size) between nsLBP and pain\u2010free controls were included. For multivariate meta\u2010analysis, two of three domains were required in each study. Random\u2010effects pairwise and multivariate meta\u2010analyses were performed. GRADE approach assessed evidence certainty. Newcastle\u2010Ottawa scale assessed risk of bias. Main outcomes were the effect size difference of domains between nsLBP and pain\u2010free controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 4519 unique records identified, 33 studies (LBP\u00a0=\u00a01552, referents\u00a0=\u00a01322) were meta\u2010analysed. Psychosocial state (Hedges\u2019 g [95%CI]: 0.90 [0.69\u20131.10], <jats:italic>p\u00a0<\/jats:italic>&lt;\u00a00.001) in nsLBP showed larger effect sizes than nervous system (0.31 [0.13\u20130.49], <jats:italic>p\u00a0<\/jats:italic>&lt;\u00a00.001; difference: 0.61 [0.36\u20130.86], <jats:italic>p\u00a0<\/jats:italic>&lt;\u00a00.001) and spine imaging biomarkers (0.55 [0.37\u20130.73], <jats:italic>p\u00a0<\/jats:italic>&lt;\u00a00.001; difference: 0.36 [0.04\u20130.67], <jats:italic>p<\/jats:italic>\u00a0=\u00a00.027). The relationship between domains changes depending on if pain duration is acute or chronic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Psychosocial effect sizes in nsLBP are greater than those for spinal imaging and nervous system biomarkers. Limitations include cross\u2010sectional design of studies included and inference of causality. Future research should investigate the clinical relevance of these effect size differences in relation to pain intensity and disability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Registration<\/jats:title><jats:p>PROSPERO\u2010CRD42020159188.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>Spinal structural lesions (e.g. intervertebral disc degeneration), psychosocial (e.g. depression) and nervous system factors (detected by e.g. quantitative sensory tests, structural and functional measures) contribute to non\u2010specific low back pain. However, psychosocial factors may be more compromised than nervous system and spinal imaging biomarkers. This relationship depends on if the pain is acute or chronic. These findings underscore that the \u2018non\u2010specific\u2019 label in back pain should be reconsidered, and more specific multidimensional categories evaluated to guide patient management.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ejp.1883","type":"journal-article","created":{"date-parts":[[2021,11,8]],"date-time":"2021-11-08T15:33:45Z","timestamp":1636385625000},"page":"578-599","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Relative contributions of the nervous system, spinal tissue and psychosocial health to non\u2010specific low back pain: Multivariate meta\u2010analysis"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3669-4131","authenticated-orcid":false,"given":"Scott D.","family":"Tagliaferri","sequence":"first","affiliation":[{"name":"Deakin University Institute for Physical Activity and Nutrition School of Exercise and Nutrition Sciences Geelong Victoria 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