, 2006). The first is the direct or ‘main’ effect model whereby it is thought that having greater levels of social support promotes general good health and therefore less risk of developing illness. The second

model is the ‘stress buffering’ model whereby social support acts to alleviate and reduce stress, which then lessons the chance of illness or speeds recovery after adversity. In view of this reviews’ findings on the association between informal social support and psychological outcomes and lack of findings on risk there appears to be greater supportive evidence of the latter model. The evidence from the association of informal social support and psychological outcome suggests that those with spinal pain who report greater detrimental psychological outcomes (e.g. greater catastrophising, greater click here kinesiophobia and greater depression) also report lower levels Sunitinib supplier of informal support. It is well established that psychological factors have been shown to play an important part on the prognosis associated with spinal pain ( Keefe et al., 2004 and Pincus et al., 2002). The level and type of informal social support may be an important factor for psychological

well-being and this may have a moderating effect between psychological outcomes and spinal pain. However most of the studies that considered these associations within this review are low quality, have small sample sizes, report univariate findings and are cross-sectional in design. Calpain Consequently it is difficult to ascertain whether social support influences psychological reactions to pain or vice versa. Furthermore studies using univariate analysis failed to adjust for the variation effect of pain intensity which has been shown to have strong associations with psychological outcomes such as depression ( Keefe et al., 2004). Considering the findings on occurrence and prognosis from longitudinal cohort designs, the results on the influence of informal social support are inconclusive, inconsistent or insufficient. This is mainly due to the

low number of studies that can be included within anyone analysis group, for example the association between satisfaction of support and prognosis was only reported by one study and so no synthesis could be made. Nevertheless, taking an overall view for risk of occurrence, of nine reported findings from the five studies, only two studies reported minor significant effects, suggesting that overall social support is unlikely to be a risk factor for spinal pain. For prognosis, of the three studies reporting nine findings, two of those findings were insufficient due to having only one study and a further four findings were inconsistent but the significant effects were larger than those reported for occurrence (OR > 2) suggesting more evidence is needed. Interestingly studies on neck pain appeared to report the clearest evidence of an effect, with Khatun et al.