Establishing a theoretical basis for research in musculoskeletal epidemiology: a proposal for the use of biopsychosocial theory in investigations of back pain and smoking

OBJECTIVE: This article discusses the need for theoretical foundations in epidemiological research of musculoskeletal conditions and suggests the use of biopsychosocial theory when designing epidemiological studies. The association between smoking and back pain is used as an example. DISCUSSION: Theory-driven musculoskeletal epidemiologic research is not common. In the epidemiological study of musculoskeletal conditions, there are multiple potential causes of a disease or disorder. Classic biomedical theory is not well suited to explain such phenomena. Biopsychosocial theory is a means through which investigators might formulate hypotheses for testing relationships between smoking, back pain, and other variables. Various types of conceptual frameworks and analytical models can be informed by biopsychosocial theory. CONCLUSION: Biopsychosocial theory is well suited for public health and epidemiological studies on musculoskeletal conditions, such as the relation between back pain and smoking, and may be useful to address the multivariable inputs for this association. Although it is not a perfect model, it provides theoretical guidance to inform the research question, an element of research design that is lacking in modern-day epidemiologic reports.