Goubert D.1, Danneels L.1, Crombez G.1, Meeus M.1
1University Ghent, Ghent, Belgium
Background: The relationship between biomechanical issues, pain and psychosocial factors in low back pain (LBP) is complex. Psychosocial factors are known to have a strong influence on pain and on the other hand, also pain affects the psychological function. These relations are mainly investigated in those with chronic pain. Given the clinical differences between LBP patients with severe chronic complaints, mild chronic complaints and those with recurrent complaints, it is also plausible that the contribution of psychological factors differs. Few research however distinguishes recurrent LBP (RLBP) from chronic severe and mild LBP (CLBP), even though RLBP patients seem to recover after every episode, whereas CLBP patients are not.
Purpose: To evaluate differences and similarities in psychosocial factors between RLBP, mild CLBP (3-4 pain days a week) and severe CLBP (7 pain days a week). Insights in psychosocial differences between these LBP groups might lead to more effective treatment methods and potential relevant measures in preventing chronicity.
Methods: The checklist of individual strength (CIS), hospital anxiety and depression scale (HADS), multidimensional pain inventory (MPI), pain catastrophizing scale (PCS), pain disability index (PDI), survey of pain attitudes (SOPA) and social characteristics were investigated in 21 RLBP, 23 mild CLBP and 16 severe CLBP.
Results: In RLBP, the PDI, MPI (pain severity and interference) and SOPA (disability) were significantly lower compared to severe CLBP. Also a significant lower CIS (subjective fatigue, motivation, concentration, activity), HADS (fear and depression), MPI (pain severity and Interference) was seen in RLBP compared to mild CLBP, but not to CLBP. A worse score on CIS (concentration) was found in mild CLBP compared to severe CLBP. No differences between groups were found for social factors such as civil state, education level or job characteristics.
Conclusion(s): The psychological state between RLBP and CLBP clearly differs. Severe CLBP experience a higher severity of pain and interference in daily living and are more disabled compared to RLBP. Mild CLBP experience more subjective fatigue, concentration problems, motivation problems, anxiety and depressive feelings and disability compared to RLBP. They are less physically active and experience their pain as more severe compared to RLBP. Whether these findings are cause or consequence of the typical nature of LBP is yet unknown. Possibly, patients with RLBP are less likely to develop a negative mindset, because they only experience short episodes of pain flares alternated with longer pain free periods. But it is also possible that a positive mindset might help RLBP to recover after every pain episode and prevent them from becoming chronic. Few differences between mild and severe CLBP were seen for psychological factors and no differences between groups were found for social factors.
Implications: Because clear differences exist between RLBP and CLBP, treatment methods for both groups should not be muddled in physical therapy practice. These differences enhance the need for different approaches between RLBP and CLBP. Tailored treatment methods with attention to the demanded psychological features in CLBP are strongly advised.
Funding acknowledgements: none
Topic: Mental health
Ethics approval: The local ethical committee from the University hospital of Ghent (EC UZ 22012/791).
All authors, affiliations and abstracts have been published as submitted.
