Network analysis of 22 864 acute and chronic back pain individuals in the UK Biobank

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Introduction Back pain is a prevalent condition, with approximately one-third of acute cases becoming chronic. The neuroimmune system, which mediates interactions between the central nervous system and immune system, may drive this transition. Although individual neuroimmune factors such as well-being, inflammation, and physical activity have been studied in back pain, their interplay and its impact on pain chronicity, remains unclear. Network analysis offers a powerful approach to assess multivariate relationships, providing a comprehensive view of their interconnections. Clarifying these interactions could uncover mechanisms underlying back pain and guide interventions. Material and Methods We utilized data from 22 864 UK Biobank participants, including 5716 individuals with acute back pain, 5716 with chronic back pain, and 11 432 pain-free controls. Variables assessed included well-being (via Patient Health Questionnaire-4), stressful life events within the past 2 years, C-reactive protein (CRP; mg/L), physical activity (via International Physical Activity Questionnaire), and relevant covariates. Network analysis was performed to explore the structure and strength of relationships between these variables across groups. Pairwise comparisons of network structures were performed to evaluate differences in network structure and global strength between groups. Results Network analysis revealed strong intra-group correlations within well-being subscales (depression, unenthusiasm, tiredness, and tenseness) and within physical activity subscales (vigorous, moderate, and walking) across groups. CRP levels demonstrated a strong positive correlation with BMI in all groups. However, the relationships between well-being, stressful life events, CRP, and physical activity were generally weak across groups. The network comparison test showed no differences in network structure or global network strength between groups. Conclusion The network analysis provided insights into the interrelationships between well-being, stressful life events, CRP, and physical activity in back pain for the first time. Results do not support involvement of neuroimmune pathways in acute back pain or pain chronification based on the variables examined. Future research incorporating a broader range of inflammatory and psychological variables as well as prospective data are needed to further elucidate the mechanisms underlying the multifactorial nature of back pain. Publication History Article published online: 24 November 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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