Table 1.

Psychosocial risk factors and clinical recognition through patient report

Psychosocial domain	Clinical recognition, patient reports
Stress/anxiety	- Little or no control the important aspects of their life - Forgetfulness - Problems with sleep (onset, early awakening) - Drastic changes in appetite/diet - Weight gain or losing weight - Noticing increase in pain during stress emotional events - Novel use of recreational or prescribed drugs (e.g., alcohol) - Changes in sex drive
Depression	- Helplessness, crying or inability, sadness, low energy - Little or no interest in previously pleasurable activities - Negative thoughts about one’s self and the future - Actual or thought of self-harm (e.g., suicidality) - Notable changes in their routines or other behaviours - Difficulty sleeping or sleeping too much - Agitation - Slowing of thoughts and reduction of physical movement - Feelings of worthlessness or inappropriate guilt - Poor concentration or difficulty making decisions - Feelings of being a burden to others in their life - Changes in sex drive
Pain-contingent rest	- Using resting as a primary pain coping strategy - Avoidance of basic physical activity due to pain
Spousal/partner social support	- Spouse/partner is active in doing much of their daily activities (solicitous: “tries to get me to rest,” “does some of my chores”) - Spouse is often angry with them, there is notable tension between them (negative or punishing: “gets angry with me”)
Pain catastrophizing	- Extensive worrying about their pain (rumination: “I worry all the time about whether the pain will end”) - Difficulty disengaging from thoughts of other distressing pain events (magnification: “I keep thinking of other painful events”) - Little hope they can self-manage their pain in anyway (helplessness: “I feel like I can’t go on”)