1Ted Findlay, DO, CCFP, FCFP, 2Dr. Eugene Wai, MD, MSc, CIP, FRCSC,

1Medical Staff, Calgary Chronic Pain Centre at Alberta Health Services, Calgary, Alberta. 2Associate Professor, University of Ottawa Division of Orthopaedic Surgery, Cross Appointment to School of Epidemiology and Public Health, Ottawa, ON.


Abstract: It has long been recognized that, following an intervention, two patients with very similar or even identical pathophysiology can have dramatically different outcomes. There is increasing recognition of the role and importance of the social determinants of health as a factor in explaining these differences. This article reviews a number of recent studies that explain the impact of these social determinants, specifically in chronic pain and low back pain. It includes commonly used screening tools and advice for interventions.
Key Words: Social determinants of health, chronic pain, low back pain, screening, social prescription.

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1. According the World Health Organization, the impact of the social determinants of health on health and illness may outweigh that of health care or lifestyle choices.
2. The social determinants of health identified as being of the most importance specifically for low back pain include education and job position.
3. Most communities across Canada will include a number of resources that can be readily accessed as part of a "Social Prescription".
1. Incorporating social work support at an early stage may have the potential to improve treatment compliance and outcomes for those low back pain patients who have notable challenges related to the social determinants of health.
2. Well validated and easily utilized screening tools already exist for the routine screening of social determinants of health.
3. Sleep disorders are shown to affect nearly half of all people reporting chronic pain, with a bidirectional relationship.
Proper patient selection and pre-operative optimization of all modifiable factors improve outcomes and decrease the possibility of FBSS.
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