DO PSYCHOSOCIAL FACTORS AND NOCICEPTIVE STIMULI PROCESSING INFLUENCE PAIN AND DISABILITY IN (SUB)-ACUTE LOW BACK PAIN? A PROSPECTIVE COHORT STUDY

A. Foubert1, E. Cleenders2, M. Sligchters3, L. Heystee3, K. Wouters4, M. Meeus5,6, P. Vaes3,7, J. Nijs3,7, N.A. Roussel5
1Antwerp University, Rehabilitation Sciences and Physiotherapy, Antwerp, Belgium, 2KU Leuven, Statistics Research Centre, Leuven, Belgium, 3Vrije Universiteit Brussel, Physical Education & Physiotherapy, Brussels, Belgium, 4University Hospital Antwerp (UZA), Scientific Coordination and Biostatistics, Antwerp, Belgium, 5Antwerp University, Rehabilitation sciences and Physiotherapy, Antwerp, Belgium, 6Ghent University, Rehabilitation Sciences and Physiotherapy, Ghent, Belgium, 7University Hospital Brussels, Physical Medicine and Physiotherapy, Brussels, Belgium

Background: The clinical presentation and pain experience of patients with (sub)-acute low back pain (LBP) can strongly vary in clinical practice. However, despite growing evidence that psychosocial factors are predictors for disability in chronic pain conditions including LPB, studies examining the relation between psychosocial factors and nociceptive stimuli processing are still lacking in (sub)-acute LBP.

Purpose: The aim of this prospective cohort study is to determine the relation between psychosocial factors and nociceptive stimuli processing in (sub)-acute LBP at baseline and the influence of these factors on pain and disability after 3 months.

Methods: 84 patients with (sub)-acute LBP were subjected to a baseline evaluation i.e. conditioned pain modulation (CPM) and a battery of questionnaires to asses pain intensity using the Visual Analogue Scale (VAS), disability using the Quebec Back Pain Disability Scale (QPBDS), pain catastrophizing using the Pain Catastrophizing Scale (PCS), kinesiophobia using the Tampa Scale for Kinesiophobia (TSK) and illness perceptions using the Illness Perceptions Questionnaire Brief version (IPQ-B). At 3 months follow-up, participants were asked to fill in the VAS and QBPDS again. A multiple linear regression analysis was conducted to determine the clinical importance of baseline factors at follow-up.

Results: 63 patients participated at the follow-up evaluation. Multiple linear regression analysis revealed that kinesiophobia and catastrophizing accounted for respectively 9,8% and 8,1% of the variation in disability after 3 months follow-up. CPM was only responsible for a small 5,7% difference in pain intensity.

Conclusion(s): Baseline psychosocial factors such as kinesiophobia and catastrophizing are predictors for future disability status in (sub)-acute LBP, whereas the predictive value of baseline nociceptive stimuli processing on future pain intensity still remains unclear.

Implications: With this information in mind, it would be possible to early identify factors that can or cannot be modified in patients who are at risk for developing longstanding LBP and decrease the risk of poor recovery by informing patients with maladaptive psychosocial variables.

Funding, acknowledgements: This research received an Antwerp University research funding for PhD-candidates, without any funding agency in public, commercial, or not-for-profit sectors.

Keywords: Low back pain, Psychosocial factors, Nociceptive stimuli processing

Topic: Musculoskeletal: spine

Did this work require ethics approval? Yes
Institution: University Hospital Brussels (UZ Brussels/VUB)
Committee: Medical ethics commitee UZ Brussels
Ethics number: Internal file number: 2012/075. BUN: 143201213717


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