American and Japanese chronic low back pain patients: cross-cultural similarities and differences

The study compared and contrasted medical, psychological, social and general behavioral functioning of American and Japanese low back pain patients and normal controls. The Sickness Impact Profile and a standardized Medical Examination Protocol for Pain instrument were used to assess all subjects. Findings showed that the American and Japanese low back pain patients had similar and significantly higher medical-physical findings than their respective controls. Likewise, the American and Japanese low back pain patients showed significantly greater psychological, social, and general behavioral dysfunction compared to control subjects. Finally, despite similar medical and physical findings, the Japanese low back pain patients were significantly less impaired in psychological, social, vocational, and avocational functioning than the American low back pain patients. It was concluded that there were significant cross-cultural differences between the American and Japanese low back pain patients, primarily in the psychosocial and behavioral areas. However, given the small sample size, any conclusion should be considered with caution; replication is needed before more definite conclusions are possible.     

Psychosocial differences as predictors for recovery from chronic low back pain following manipulation, stabilizing exercises and physician consultation or physician consultation alone.

OBJECTIVE: Three psychosocial profile groups are introduced in the Multidimensional Pain Inventory for chronic pain patients. Patients with the dysfunctional profile have shown a more favourable outcome after multidisciplinary treatments, due to the suggested effects of specific psychosocial treatment elements. In this study we explored, among patients with chronic low back pain, whether the Multidimensional Pain Inventory patient profile groups might respond differently to treatment without planned psychosocial elements. METHODS: Of 204 voluntarily recruited patients with chronic low back pain, 102 were randomized to a combined manipulation, exercise and physician consultation group (called the combination group) and 102 to a consultation-alone group. RESULTS: Although all subjects showed improvement during follow-up both on the Oswestry index and the Visual Analogue Scale, the dysfunctional profile patients in the combination group improved the most. Their high pre-treatment ratings on Oswestry and Visual Analogue-scales fell at the 5- and 12-month follow-ups to the same level as those of the adaptive copers or interpersonally distressed patients, and they were on a significantly lower level than the dysfunctional profile patients in consultation group during follow-up. All dysfunctional profile patients also showed a decrease in affective distress, equally in combination and consultation groups. CONCLUSION: We suggest that dysfunctional profile patients are more sensitive to respond even to treatment without any specific psychosocial elements. This should be considered when evaluating any treatment effects. Among dysfunctional profile patients, pain-related anxiety and decreased acceptance of pain may contribute to their sensitivity to treatment.     

Psychosocial Differences Between High-Risk Acute vs. Chronic Low Back Pain Patients

▪ Abstract:   The present study was designed to evaluate the relative degree and type of emotional distress in high-risk acute low back pain (ALBP) subjects (defined as less than 3 months since initial injury) vs. high-risk chronic low back pain (CLBP) subjects (defined as greater than 3 months since initial injury). It is an extension of earlier findings that demonstrated the significant role that such emotional distress may play in the development of CLBP disability if not appropriately treated in the acute phase. This work stems from a conceptual three-stage model, which characterizes the progression from acute to chronic pain. Several psychosocial measures were administered that included information allowing for the classification of subjects as high-risk based upon an earlier developed screening algorithm. The ancova procedure in SPSS was used to compare groups, controlling for gender, ethnicity, and age. Results revealed that CLBP subjects had higher rates of certain measures of emotional distress and depression relative to ALBP subjects. These findings further support the importance of effectively managing emotional distress factors early, when treating musculoskeletal disorders such as low back pain. ▪     

Chronic low back pain: Physical training,graded activity with problem solving training,or both? The one-year post-treatment results of a randomized controlled trial

Several treatment principles for the reduction of chronic low back pain associated disability have been postulated. To examine whether a combination of a physical training and an operant-behavioral graded activity with problem solving training is more effective than either alone in the long-term, a cluster randomized controlled trial was conducted. In total 172 patients, 18-65 years of age, with chronic disabling non-specific low back pain referred for rehabilitation treatment, were randomized in clusters of four consecutive patients to 10 weeks of aerobic training and muscle strengthening of back extensors (active physical treatment; APT), 10 weeks of gradual assumption of patient relevant activities based on operant-behavioral principles and problem solving training (graded activity plus problem solving training; GAP), or APT combined with GAP (combination treatment; CT). The primary outcome was the Roland Disability Questionnaire adjusted for centre of treatment, cluster, and baseline scores. Secondary outcomes were patients' main complaints, pain intensity, self-perceived improvement, depression and six physical performance tasks. During the one-year follow-up, there were no significant differences between each single treatment and the combination treatment on the primary outcome, the Roland Disability Questionnaire. Among multiple other comparisons, only one significant difference emerged, with GAP and APT showing higher self-perceived improvement than CT. We conclude that the combination treatment integrating physical, graded activity with problem solving training is not a better treatment option for patients with chronic low back pain.     

Chronic low back pain and psychosocial issues

Psychosocial factors are at least as important as biomedical factors in the onset, maintenance, and treatment of chronic low back pain. This article reviews some of the common psychosocial factors that influence the course of pain from acute to chronic status, cognitive behavioral interventions used to alter dysfunctional pain cognitions, and avoidance behaviors and the emotional distress that can accompany pain and pose barriers to recovery. The interplay of cognitive, emotional, behavioral, biomedical, and social factors is described using a fear avoidance model. Interdisciplinary pain rehabilitation is discussed as an effective option for more biopsychosocially complex patients.     

A comparison of health locus of control beliefs in low-back patients from the U.S. and New Zealand

In order to study differences in health control attitudes between chronic low-back patients from the U.S. and New Zealand, the Health Locus of Control (HLC) was administered to 284 consecutive admissions to pain clinics in those countries: 96 patients seen at the Auckland (New Zealand) Pain Clinic and 188 seen at the University of Virginia (U.S.) Pain Clinic. The HLC is an 11-item instrument [23] that assesses general control over health matters. Principal component factor analyses indicated 3 distinct subscales for the low back patients: (a) personal health control, (b) external health control, and (c) control by powerful others (physicians). HLC responses were analyzed with univariate analyses of variance using subscale scores as dependent measures and country and sex as independent variables. New Zealanders rated themselves as less dependent on physicians' orders (F (1,280)=3.92, P less than 0.05), and women were seen as having less personal control over their pain conditions than men (F (1,280)=6.29, P less than 0.02). The differences related to sex and country are discussed within a social learning framework. Suggestions are made for future cross-cultural research, especially related to issues of dependency on others for health control and outcomes in the treatment of chronic pain.     

Sex and pain-related psychological variables are associated with thermal pain sensitivity for patients with chronic low back pain.

Biologic and psychological associations with evoked pain sensitivity have been extensively studied in healthy subjects but not among subjects with clinical pain syndromes. This study involved patients with chronic low back pain and investigated whether: 1) sex differences existed for thermal pain sensitivity; and 2) sex, fear-avoidance beliefs, and/or pain catastrophizing influenced thermal pain sensitivity. Thirty-three consecutive patients enrolled in a pain rehabilitation program completed self-report questionnaires and underwent quantitative sensory testing with an established protocol for thermal stimuli. Women had elevated pain sensitivity for measures of tolerance and temporal summation but not for first pulse response. In the multivariate models predicting thermal pain sensitivity, sex was associated with tolerance, and fear-avoidance beliefs were associated with first pulse response. Sex and pain catastrophizing were associated with temporal summation of thermal pain. Future studies involving clinical samples are necessary to replicate these findings and to explore the involvement of cortical structures. PERSPECTIVE: This study suggests that sex, fear-avoidance beliefs, and pain catastrophizing were associated with thermal pain sensitivity for patients with chronic low back pain. These results corroborated sex differences in tolerance and temporal summation observed in the experimental pain literature for healthy subjects. These results also suggest the potential for these specific pain-related beliefs to be associated with a sensitized state because previous studies have demonstrated their association to clinical pain reports, and this study demonstrated associations with thermal pain sensitivity.     

Strategies to build and maintain competence in pain management: Insights from a SIAARTI survey on educational needs among Italian anesthesiologists

Purpose

Fulfilling educational needs in pain management should be a lifelong process, even involving physicians board certified in pain medicine such as the anesthesiologists/pain therapists. The aim of the study was to investigate Italian anesthesiologists' self-perceived competency, confidence, and interest to attend educational programs in relation to their seniority in pain management.

Methods

SIAARTI members were sent an online questionnaire addressing the following items: education, skills (both soft and hard skills), technical expertise and engaged to participate between December 2020 and January 2021. Participants rated their competence based on the following range (no knowledge, knowledge, competence) while their agreement to attend educational courses was assessed using a 5-point Likert-type scale.

Results

Less than one in four participants declare to be dedicated to pain medicine activity with greater proportion among older (over 61 years) compared to younger ones (31–40 years). Regarding cancer and chronic noncancer pain a positive gradient of self-perceived competence has been observed in relation to seniority. In contrast, no gradient of self-perceived competence was reported about musculoskeletal and low back pain. Participants self-perceived competent in both opioid use and prevention of opioid-related adverse event while feeling less competent when managing drugs with abuse potential. The lowest competence has been observed in pediatric pain along with the lowest interest to attend educational courses. Participants were much and very much interested to education regarding cancer, noncancer, musculoskeletal, and low back pain, invasive analgesic procedures but less regarding items for which they declared less competence, such as use of pain scales, pain management in children, and use of drugs with abuse potential.

Conclusion

This work provides first evidence of a summative assessment of competency and related educational needs' profile of anesthesiologists/pain therapists thus paving the way for developing a nationwide educational program to improve chronic pain care in Italy.     

Reliability, validity and responsiveness of the fear-avoidance beliefs questionnaire: methodological aspects of the Norwegian version.

OBJECTIVE: To evaluate reliability, validity and responsiveness of the Fear-Avoidance Beliefs Questionnaire (FABQ) for use in Norwegian patients with low back pain. DESIGN: A prospective cohort study with 2 groups. PATIENTS: The questionnaire was tested in 123 patients with acute low back pain and 50 patients with chronic low back pain. METHODS: A translation and cross-cultural adaptation was performed. Test-retest reliability was assessed in 28 patients with chronic low back pain. Responsiveness was assessed in acute low back pain. RESULTS: Two factors for the FABQ were confirmed; fear-avoidance beliefs about work (FABQ-Work) and physical activity (FABQ-PA), accounting for 60% and 54% of the total variance in acute and chronic low back pain, respectively. For FABQ-Work and FABQ-PA internal consistency was 0.90 and 0.79, intra-class correlation coefficients 0.82 and 0.66, minimal detectable changes 12 and 9 points, and coefficients of variation were 16% and 23%. The FABQ correlated weakly to moderately with pain, disability, distress, and clinical variables. Standardized response means were low for FABQ-Work (0.32) and moderate (0.56) for FABQ-PA. Both FABQ subscales showed initially floor and/or ceiling effects. CONCLUSION: The Norwegian FABQ version had acceptable factor structure, internal consistency, test-retest reliability and construct validity. The responsiveness of the FABQ-Work was low, and for the FABQ-PA moderate, in the acute sample.     

Pilates-based core exercise improves health-related quality of life in people living with chronic low back pain: A pilot study

PurposeTo investigate the effects of Pilates exercise on improving health-related quality of life in people living with chronic low back pain.MethodsThis was a single-blind, randomised clinical trial. Thirty-nine physically active subjects aged between 30 and 70 years with nonspecific chronic low back pain for more than three months were recruited. The study employed a pretest-posttest design, with a 4 -, 8 -, and 26-week follow-up. For eight weeks, the intervention group participated in a group-supervised, mat-based Pilates program, while the control group received the usual pharmacologic and rehabilitation standard of care, including patient education on chronic low back pain. The primary outcome was self-perceived health status measured using the EQ-5D questionnaire in a structured form and a visual analogue scale. Secondary outcomes included intensity of pain and degree of disability.ResultsBy the end of the 8-week Pilates program, the intervention group achieved a better health-related quality of life on the EQ-5D visual analogue score than the control group. In assessing the trends in each individual group regarding pain, the intervention group demonstrated an earlier pain reduction than the control group that lasted until the end of the trial.ConclusionsAn 8-week supervised Pilates-based core exercise program is an effective therapeutic modality for improving self-perceived health status in patients with chronic low back pain. This finding could inform clinicians of better alternatives when they suggest exercise interventions for chronic low back pain.     

Determinants of return-to-work among low back pain patients

This prospective study identifies physical, behavioral, and psychosocial correlates of subsequent employment status in a sample of low back pain patients. The sample of 150 subjects was drawn from 2 populations of persons with chronic low back pain: 87 individuals who were receiving care at a university low back pain clinic, and 63 individuals who had applied for (but not yet received) Social Security compensation on the basis of low back pain. All subjects had worked at least 3 months prior to their latest unemployment period and were currently out of work. Initial assessment included a medical history, physical examination, biomechanical testing, psychiatric interview, and MMPI testing. All subjects were followed up 6 months later to determine whether they had returned to work. Cross-sectional group comparisons at the time of initial assessment showed that, after controlling for the effects of age, the two samples differed on several physical and biomechanical measures, the Social Security group reflecting a more chronic picture. Group differences on physical variables were found, but most significant differences disappeared when adjusted for length of time out-of-work. Longitudinal analyses showed that few objective physical or biomechanical measures were associated with return-to-work at 6 months, while a number of psychosocial variables were significant predictors of 6-month work status. The data suggest that exclusive reliance on the physical examination to determine level of disability, without consideration of psychosocial conditions, and without adjusting for the confounding effects of age and length of time out-of-work, is not empirically justified. Logistic regression analysis was used to ascertain the relative contribution of each predictor to outcome and to illustrate the hypothetical effects of changes in the levels of selected risk factors on the likelihood of return-to-work. Implications for interventions with low back pain patients are discussed and future research directions suggested.     

Are childhood adversities relevant in patients with chronic low back pain?

Previous studies have found a high number of childhood adversities in patients with chronic low back pain, particularly in patients reporting persisting problems after back surgery. Our aim was to reproduce these results.Within the framework of a comprehensive diagnostic assessment and psychometric evaluation, 109 inpatients who had been treated for low back pain were examined in the orthopedics department of a German university hospital. Five risk factors investigated by Schofferman and his staff (Schofferman et al., 1993) were re-assessed in all of our patients using a structured biographical interview. The German chronic low back pain group was also compared with an age- and gender-matched control group of 109 non-chronic pain patients with respect to these childhood adversities and additional ones.Only approximately 11% of the German chronic low back pain sample demonstrated three or more risk factors, compared with more than 50% in Schofferman's sample, and 47.7% showed none of the five risk factors, compared to only 11% in the Schofferman sample. Moreover, no significant differences in distribution either in terms of the individual risk factors or their cumulative frequency were found in the German chronic low back pain group compared with an age and gender-matched control group without chronic pain.Childhood adversities do not occur frequently in a non-selected group of patients with chronic low back pain. Earlier results showing an increased likelihood of the occurrence of psychosocial risk factors could not be confirmed. As a consequence, further psychic or psychosomatic diagnostics of patients with chronic low back pain are needed to define diagnostic subgroups.     

Pain, disability, and satisfaction outcomes and predictors of outcomes: a practice-based study of chronic low back pain patients attending primary care and chiropractic physicians

BACKGROUND: Few studies exist on the prognostic value of demographic, clinical, or psychosocial factors on long-term outcomes for patients with chronic low back pain. OBJECTIVE: This study reports on long-term pain and disability outcomes for patients with chronic low back pain, evaluates predictors of long-term outcomes, and assesses the influence of doctor type on clinical outcome. METHODS: Sixty chiropractic (DC) and 111 general practice (MD) physicians participated in data collection for a prospective, longitudinal, practice-based, observational study of ambulatory low back pain of mechanical origin. The primary outcomes, measured at 6 months and 12 months, were pain (by using the Visual Analog Scale), and functional disability (by using the Revised Oswestry Disability Questionnaire). Satisfaction was a secondary outcome. RESULTS: Overall, long-term pain and disability outcomes were generally equivalent for patients seeking care from medical or chiropractic physicians. Medical and chiropractic care were comparable for patients without leg pain and for patients with leg pain above the knee. However, an advantage was noted for chronic chiropractic patients with radiating pain below the knee after adjusting for baseline differences in patient and complaint characteristics between MD and DC cohorts (adjusted differences = 8.0 to 15.2; P <.002). A greater proportion of chiropractic patients were satisfied with all aspects of their care (P =.0000). The strongest predictors of primary outcomes included an interaction of radiating pain below the knee with provider type and baseline values of the outcomes. Income, smoking, comorbidity, and chronic depression were also identified as predictors of outcomes in this study. CONCLUSION: Chiropractic care compared favorably to medical care with respect to long-term pain and disability outcomes. Further study is required to explore the advantage seen for chiropractic care in patients with leg pain below the knee and in the area of patient satisfaction. Identification of patient and treatment characteristics associated with better or worse outcomes may foster changes in physicians' practice activities that better serve these patients' needs.     

Interdisciplinary Treatment of Failed Back Surgery Syndrome (FBSS): A Comparison of FBSS and Non-FBSS Patients

Abstract:   Many patients enrolled in chronic pain centers suffer from failed back surgery syndrome (FBSS). However, there has been a paucity of research concerning how these patients differ from other chronic pain patients, and how to most effectively address their complex problems within an interdisciplinary chronic pain treatment environment. The current study represents the first large-scale examination of these issues, with two major aims: (1) to elucidate the differences between FBSS patients and other chronic lumbar pain patients; and (2) to clarify the role of injections in interdisciplinary treatment, particularly with FBSS patients. A total of 128 chronic lumbar pain patients who presented for treatment at an interdisciplinary center were included in the study. Patients completed various measures at pre-, mid-, and post-treatment intervals, including physical, functional, and psychosocial measures. Overall, both FBSS and Non-FBSS patients reported significantly decreased pain and disability, and significant improvements in physical and psychosocial functioning after interdisciplinary treatment. However, Non-FBSS patients were associated with greater reductions in self-reported pain and disability than FBSS patients. On the other hand, FBSS patients were significantly more improved on physical therapy measures, including Activities of Daily Living, Strength, and Fear of Exercise. Statistical comparisons of Injection (INJ) and No-Injection (No-INJ) groups yielded few significant findings.     

Childhood traumatic events and dissociative experiences in patients with chronic headache and low back pain

OBJECTIVE: The aim of this study was to examine childhood traumatic experiences and dissociative characteristics in women with chronic headache and low back pain. SETTING: The patients were evaluated in the multidisciplinary pain clinic of a university hospital. SUBJECTS: This study included 73 patients: 41 with chronic headache and 32 with chronic low back pain. OUTCOME MEASURES: All the patients were assessed with use of a semistructured questionnaire, the Dissociative Experiences Scale (DES), the Somatoform Dissociation Questionnaire (SDQ), and the Childhood Abuse and Neglect Questionnaire. RESULTS AND CONCLUSIONS: There were no significant differences between the headache and low back pain groups in terms of prevalence of history of neglect; abuse; or sexual, physical, and emotional abuse separately. In addition, no significant differences were found between the groups with respect to the Dissociative Experiences Scale scores. However, analysis of the SDQ scores showed that the neglect rate in the two groups differed significantly. According to our findings, the neglect rate was higher in the headache group, thus warranting further research to investigate the sensitivity of the SDQ for neglect.     

AAPT Diagnostic Criteria for Chronic Low Back Pain

Chronic low back pain (CLBP) conditions are highly prevalent and constitute the leading cause of disability worldwide. The Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION) public-private partnership with the US Food and Drug Administration and the American Pain Society (APS), have combined to create the ACTTION-APS Pain Taxonomy (AAPT). The AAPT initiative convened a working group to develop diagnostic criteria for CLBP. The working group identified 3 distinct low back pain conditions which result in a vast public health burden across the lifespan. This article focuses on: 1) the axial predominant syndrome of chronic musculoskeletal low back pain, 2) the lateralized, distally-radiating syndrome of chronic lumbosacral radicular pain 3) and neurogenic claudication associated with lumbar spinal stenosis. This classification of CLBP is organized according to the AAPT multidimensional framework, specifically 1) core diagnostic criteria; 2) common features; 3) common medical and psychiatric comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors.PerspectiveAn evidence-based classification of CLBP conditions was constructed for the AAPT initiative. This multidimensional diagnostic framework includes: 1) core diagnostic criteria; 2) common features; 3) medical and psychiatric comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors.     

What is "the good back-consultation"? A combined qualitative and quantitative study of chronic low back pain patients' interaction with and perceptions of consultations with specialists.

OBJECTIVE: To identify core elements of what patients with chronic low back pain perceive as good clinical communication and interaction with a specialist ("The Good Back-Consultation"). DESIGN: Qualitative study including observation of consultations and a subsequent patient interview. Quantitative data were also recorded. SUBJECTS: Thirty-five patients with chronic low back pain referred to a specialist. METHODS: Thirty-five consultations were observed with respect to history-taking, clinical examination and interaction between patient and doctor. Patients were subsequently interviewed about how they perceived the consultation. Fourteen specialists with various specialty branches and 35 patients (18 males) participated. For 3 of the specialists a positive effect (return to work) on patients with chronic low back pain had been documented in previous randomized controlled trials. Qualitative data analysis was performed using a template method. RESULTS: Most patients thought that the history-taking and clinical examination had been thorough and satisfactory. Patients emphasized the importance of being given an explanation during the examination of what was being done and found, of receiving understandable information on the causes of the pain, of receiving reassurance, discussing psychosocial issues and discussing what can be done. The most important characteristic of "The Good Back-Consultation" was that the specialist took the patient seriously. CONCLUSION: The findings may represent an important potential for enhancing clinical communication with patients.     

A biomechanical comparison of lifting techniques between subjects with and without chronic low back pain during freestyle lifting and lowering tasks

OBJECTIVE: To evaluate if chronic low back pain patients perform manual material handling tasks differently from control subjects. DESIGN: Comparative study using a repeated measures design. BACKGROUND: No study evaluated the lifting technique of back pain patients relative to control subjects during free style lifting and lowering tasks. Previous findings suggest that lowering would be more hazardous than lifting to the low back. It would be interesting to evaluate if chronic low back pain patients behave differently than controls when lifting and lowering. METHODS: Thirty-three male subjects (18 controls, 15 suffering from non-specific chronic low back pain) participated. A 12-kg box was lifted (freestyle) from the floor to the hips (1) in front (symmetric task) or (2) to a shelf located at 90 degree on the right (asymmetric task) and was lowered back to the floor. A 3D biomechanical analysis involving the assessment of L5/S1 loading, posture of segments, inertial parameters, and EMG was performed. RESULTS: There was no difference between the groups for postural (trunk and lower limb angles), inertial (trunk velocity and acceleration), and L5/S1 loading (moments and compression) variables. The patients showed abnormally low left lumbar erector spinae (symmetric task, lowering) or high left thoracic erector spinae (all tasks) EMG activation. Significant Group x Action (lifting vs. lowering) interactions were also observed for some inertial and L5/S1 loading variables suggesting that the biomechanical differences detected between lifting and lowering may have a differential influence on the technique used by back pain patients and control subjects. CONCLUSIONS: The gross lifting technique of back pain patients was unaltered relative to controls but the activation of paraspinal muscles differed, suggesting that a more detailed biomechanical analysis, such as the use of EMG driven models, might be required to reveal lumbar impairments during lifting. RELEVANCE: To evaluate if chronic low back pain patients use naturally different lifting techniques to prevent pain exacerbation and damaged lumbar tissue overloading.     

Mexican American, nurse practitioner, and lay control group beliefs about cause and treatment of chest pain

This study compared the health beliefs of Mexican Americans concerning the specific symptom of chest pain to beliefs of a group of predominant culture nurse practitioners and a lay predominant culture control group. Two hypotheses were examined; The health beliefs of groups differ significantly with culture and the health beliefs of groups differ significantly with professional education. A 43-item structured questionnaire was developed, based on literature review and unstructured interviews with Mexican American respondents. the questionnaire was administered to three nonprobability samples of 30 subjects each: Mexican Americans, nurse practitioners, and lay controls. Significant differences were found between Mexican Americans and the predominant culture groups of nurse practitioners and lay controls on folk beliefs regarding chest pain. On some items significant differences between nurse practitioners and the lay groups of Mexican Americans and predominant culture controls were based on professional education.     

Psychosocial risks for disability in children with chronic back pain.

Psychosocial factors related to disability in adults with chronic back pain have been well studied, but little is known about factors associated with functional impairment in pediatric patients with chronic back pain. The purpose of this study was to examine whether 2 potential risk factors-use of catastrophizing as a coping technique and presence of a familial pain history-were associated with disability in pediatric back pain patients. Participants were 65 patients (ages 8-18) with chronic back pain seen at a multidisciplinary pain clinic. Patients completed measures of pain (visual analog scales), disability (Functional Disability Inventory), and catastrophizing (Internalizing/Catastrophizing subscale of the Pain Coping Questionnaire). Parents provided demographic information and familial pain history. Patients reported that chronic back pain caused disruptions in their daily functioning and they missed, on average, 2.5 days of school every month. Catastrophizing and familial chronic pain history both were significantly associated with greater disability, with use of catastrophizing being the stronger predictor of disability. This study presents important findings on potential psychosocial risk factors of functional disability in children and adolescents with chronic back pain. Future research might clarify mechanisms by which such coping styles are developed and explore how familial communication about pain might influence a child's coping ability. PERSPECTIVE: Pediatric patients seeking treatment for chronic back pain often present with substantial functional impairment that is not well explained by disease variables or pain intensity. Two important psychosocial variables (catastrophizing and familial pain history) may provide a context for a better understanding of pain-related disability in children.