Table 3.

Comorbidity drivers

	Categories	Operational definition
A	Physical comorbidities	Patients suffering from LBP often present with multiple painful musculoskeletal conditions49,50 and other physical comorbidities. Studies have shown that these other painful problems tend to worsen the severity of symptoms of LBP.51 Also, the presence of specific co-occurring pathologies, such as chronic fatigue, irritable bowel syndrome, and migraines could moderate the “nervous system dysfunction drivers” as they are linked to central sensitization. Other non-painful physical comorbidities, such as cardiac disease55 and high BMI,56–58 are also associated with chronic LBP, but their treatment implications are less certain. Although some elements might be harder to modify by short-term treatments (ie, high BMI), these could serve as motivational elements to help enhance patient engagement.
B	Mental health comorbidities	This category involves disorders of the standard classification of mental disorders, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Clinical depression is an important factor since pain and depression share some biological processes59 and both prompt neuroplastic maladaptive changes in the central nervous system.59 Besides depression, the presence of other mental disorders or psychiatric comorbidity such as general anxiety disorder60 or borderline personality disorder61 are important treatment modifiers, as they certainly challenge the therapist’s approach for the management of LBP and further moderate the effects of cognitive–emotional drivers.

Abbreviations: LBP, low back pain; BMI, body mass index.