CLBP is a complex biopsychosocial issue with financial implications for society, particularly due to the associated use of healthcare resources [24]. Current international guidelines emphasize that LBP should be managed at the primary care level, as few cases are considered medical emergencies [25].

The diagnosis and treatment of CLBP have been subjects of debate, and there is no clear consensus on optimal management [26]. Therefore, it is essential to establish clear, accessible, and personalized care pathways that promote patient adherence to treatment. For patients experiencing CLBP, there is an inevitable concern about maintaining their QOL [27]. Early and better involvement of patients in the care pathways, along with the recognition of psychosocial factors as risk factors for chronicity, are key points that must be addressed to improve overall care management and increase the likelihood of a favorable prognosis [28].

Physical rehabilitation is essential for the treatment of CLBP, but it must primarily be carried out with the appropriate level of patient adherence. It should be accessible, personalized, and, most importantly, integrated, given the significant impact of psychosocial factors in maintaining the chronicity of the condition [29].

One of the proposals of this project is, in fact, to leverage digital health to improve the management of patients with LBP. Pursuing the primary goal of this study would also allow us to highlight the limitations of current approaches by developing and optimizing an electronic health system to ensure not only a multidimensional approach but also one that is more easily accessible and tailored to the individual needs of each patient [30].

Through the use of digital platforms, it is possible to provide a personalized and integrated approach to diagnosis and treatment, thereby facilitating effective management and comprehensive care for the patient [31].

What has been seen is that LBP is a multidimensional condition that involves not only the physical component but also the psychological one, which correlates with all the areas in which the patient is engaged [32].

These comorbidities weaken the success of rehabilitation treatment, leading to the chronicization of negative symptoms. The interaction between pain and psychopathological sequelae impacts the cognitive performance of patients with chronic LBP. CLBP [33] can indeed affect cognitive functions. Patients show a reduction in problem-solving abilities, slower information processing speed, and memory impairments [34].

In [35] demonstrated that both pain intensity (VAS) and depression/anxiety scores were correlated with working memory (TMT-B) in patients with CLBP. These results also indicate the interaction between pain, depression, anxiety, and cognitive impairment. However, the reason for these cognitive deficits remains uncertain [36]. Pain may be a contributing factor because the pain itself can have an excitatory effect or act as a mental stressor. The reduction of pain-induced stress could positively affect cognitive profile [37].

In particular, psychological factors such as fear-avoidance beliefs, depression, anxiety, catastrophic thinking, and family and social stress are often poorly identified and inadequately assessed, and it has been shown that they alter pain processing pathways, perceptions, and adaptive responses [38].

Depression is frequently associated with chronic LBP, with a prevalence 2–3 times higher than in the general population [39, 40]. In patients with significant pain-related disability, such as those attending pain clinics, the prevalence is even higher, affecting the majority of them [41].

Depression tends to increase with the intensity of pain, especially when it is associated with multiple painful issues, when there are no adequate medical explanations, or when the pain becomes chronic [42].

The coexistence of depression and chronic conditions is linked to greater impairment of daily functions, an increase in symptoms without clear physical causes, greater reliance on healthcare services, and an increase in healthcare costs [5].

Although in many cases depression is a response to pain and to life experiences associated with it, in some instances, it can precede the onset of pain. While study results are not always in agreement, some research suggests that depression may predispose individuals to develop back pain [43]. When a subject is already depressed at the time of an injury, or with a history of recurrent depression, may have more negative cognitive patterns, a more passive coping style, and fewer psychological and social resources to adequately deal with the injury itself [44].

Anxiety disorders are a common comorbidity in patients with chronic pain and can significantly affect pain perception and the patient’s functionality; chronic pain can also exacerbate anxiety symptoms [45].

Although many psychological factors influence the pain experience, anxiety has independent and additive adverse effects on individuals’ functional status and their response to pain treatment [46].

Patients with undiagnosed generalized anxiety disorder (GAD) are more likely to progress from subacute pain to chronic pain [47]. The failure to recognize GAD in patients with concomitant CLBP can lead to inadequate treatment and further disability. Since both fatigue and depressive mood are subjective, early screening for each symptom and clarification of the meaning of each symptom for the patient can personalize therapeutic approaches to manage the symptom burden in CLBP [48].

Social relationships can also play an important role in LBP [49]. Psychosocial factors both in private life (e.g., poor emotional support) and at the workplace (poor social support at work, low job satisfaction) are risk factors for CLBP [50]. CLBP often has a significant negative impact on self-perception and a sense of self-efficacy. If patients feel misunderstood by others and have difficulty managing their social interactions both at home and in the workplace, there is a consequent significant perception related to the loss of their social role [51].

On the other hand, functional social relationships can provide support for patients with LBP, and this positive social support should be promoted to reduce the impact of the disease in daily life contexts [52].

Targeted therapeutic approaches will improve the clinical management of patients with a higher symptom burden, which exacerbates their pain and erodes their QoL [53]. Additionally, our protocol could be useful for testing a composite assessment tool to evaluate concomitant symptoms in patients with CLBP.

Such a standardized approach can help physicians prescribe targeted strategies for a patient presenting with multiple symptoms, as opposed to a patient who does not report other concomitant symptoms [54].

To reduce the burden of disability, it is crucial that screening for known risk predictors is performed early and functionally, and that appropriate, problem-targeted therapy is included from the outset to improve care [55]. Sensitivity to these factors could also enhance the therapeutic alliance between professionals and patients, increasing adherence to advice and treatment, as negative rehabilitation outcomes are often due to patient dropout and low levels of engagement [56].

In the long term, addressing the predictors of negative outcomes in the early stages of LBP could improve results and reduce costs by tailoring interventions to the needs of the patients [57].

The goal of our protocol is to identify all psychosocial risk factors that could worsen the patient’s condition at the time of diagnosis. To achieve this, we wanted to prepare an ad hoc assessment that took into account the under-researched dimensions, such as the sexual sphere, family dynamics, dysfunctional communication, appetite-related issues, and potential links to eating disorders, even considering the attribution of causes. Place emphasis on those often-overlooked areas allow to quantify and analyze how these factors may impact patients’ wellbeing and hinder the care process and recovery. In this way, it could fill the gap by creating a holistic and validated methodology capable of early identification of patients at risk of psychological deterioration, while also enabling timely intervention. This would not only improve patient wellbeing but also reduce the risk of long-term complications and, as a result, decrease the economic impact associated with the disease, both in terms of direct and indirect health care costs (e.g., absenteeism from work).

We expect a shift in the treatment of CLBP, shifting from a model predominantly focused on the physical component of pain to a more integrated model that considers all the aspects contributing to the patient’s wellbeing.

This is because the challenge associated with treating non-specific CLBP lies in the complex and multifactorial interaction between genetic, bio-physical, psychosocial, health, and lifestyle factors, which are largely individualistic [58].

A patient with better disease-specific knowledge—who understands the cause and the pathophysiological mechanism of the disease and has a proper understanding of prevention and treatment options—can more effectively and actively participate in prevention or rehabilitation. Therefore, patient education is an essential part of primary prevention to prevent the disease, secondary prevention to reduce the impact of the disease, and tertiary prevention to mitigate the disease’s impact [59, 60].