Understanding Pain and Depression in Back Pain: the Role of Catastrophizing,Help-/Hopelessness,and Thought Suppression as Potential Mediators

Purpose

The cognitive mediation hypothesis describes the influence of psychological factors on the relationship between pain and depression such as cognitions of catastrophizing and help-/hopelessness. More recent research also emphasizes the role of suppression of negative thoughts and experiences such as pain. However, there is little research investigating direct and indirect effects of these contrasting cognitions.

Method

A total of 164 acute and sub-acute non-specific back pain patients participated in this study. Pain intensity, depression, and pain-related cognitions were measured using questionnaires, such as the Beck Depression Inventory and the Kiel Pain Inventory. Data were analyzed using structural equation modeling.

Results

The results of the path analysis support the hypothesis that cognitive coping strategies have a mediating effect on pain and depression. Consistent with previous research, we found that pain had no direct relation with depression. Help-/hopelessness had a direct path to depression, whereas catastrophizing had an indirect effect via increased help-/hopelessness. The current results also indicate that thought suppression mediated the relationship between pain and depression via both direct and indirect effects.

Conclusion

Cognitive mediators, such as help-/hopelessness, catastrophizing, and thought suppression, have a significant impact on depression in patients with acute and sub-acute back pain. The current results may aid in the optimization of treatments for these patients by focusing attention toward the modification of dysfunctional cognitive pain-coping strategies.

     

Depression History,Stress, and Pain in Rheumatoid Arthritis Patients

This study examined the role of past episodes of depression on pain reports for patients with rheumatoid arthritis (RA) before and during stress induction. A history of major depressive episodes was assessed by diagnostic interviews for 138 RA patients, 74 who later participated in a set of laboratory procedures designed to induce interpersonal stress. Patients were evaluated by a rheumatologist and then asked to report joint and bodily pain throughout the laboratory study. We found that RA patients with a history of two or more episodes of major depression had more pain at baseline, and exhibited higher pain in response to the stress induction than did RA patients with either only one episode or no history of depression. Such findings provide new insight in the dynamic relationships between depression, stress, and pain.     

Cognitive Predictors of Depression in Chronic Low Back Pain: Toward an Inclusive Model

Previous research has linked cognitive distortion, perceived interference with instrumental activities, and self-control to depression in chronic pain patients, though to date no study has examined all three variables concurrently. The present study investigated these three cognitive mediators in a comprehensive model to determine whether each variable represented an independent dimension in the pain-depression relationship. Results in a sample of 74 chronic low back pain patients revealed that a regression model containing all three cognitive variables had the strongest association with depressive symptoms. Consistent with a cognitive mediational model of the pain-depression relation, when self-control, cognitive distortion, and interference were held constant, pain and disability did not have a significant association with self-reported depression. These findings indicate that a comprehensive cognitive model of depression and chronic pain will need to incorporate all three cognitive variables.     

The Key Role of Pain Catastrophizing in the Disability of Patients with Acute Back Pain

Purpose

This study investigated the role of anxiety sensitivity, resilience, pain catastrophizing, depression, pain fear-avoidance beliefs, and pain intensity in patients with acute back pain-related disability.

Method

Two hundred and thirty-two patients with acute back pain completed questionnaires on anxiety sensitivity, resilience, pain catastrophizing, fear-avoidance beliefs, depression, pain intensity, and disability.

Results

A structural equation modelling analysis revealed that anxiety sensitivity was associated with pain catastrophizing, and resilience was associated with lower levels of depression. Pain catastrophizing was positively associated with fear-avoidance beliefs and pain intensity. Depression was associated with fear-avoidance beliefs, but was not associated with pain intensity. Finally, catastrophizing, fear-avoidance beliefs, and pain intensity were positively and significantly associated with acute back pain-related disability.

Conclusion

Although fear-avoidance beliefs and pain intensity were associated with disability, the results showed that pain catastrophizing was a central variable in the pain experience and had significant direct associations with disability when pain was acute. Anxiety sensitivity appeared to be an important antecedent of catastrophizing, whereas the influence of resilience on the acute back pain experience was limited to its relationship with depression.

     

Recall Bias in Patients with Chronic Low Back Pain: Individual Pain Response Patterns Are More Important Than Pain Itself!

Background

Patients’ cognitive processing of pain-related information as well as their cognitive, affective and behavioral response pattern when experiencing pain in daily life has been shown to be associated with poorer prognosis in low back pain. However, the relationship between specific cognitive processes such as recall of pain-related material and individual pain responses remains unknown.

Purpose

The present study sought to investigate recall bias in patients with chronic low back pain (CLBP) compared to healthy controls. Furthermore, it was aimed to investigate the impact of patients’ individual pain-related responses on recall bias, comparing fear-avoidance response (FAR), endurance response (ER) and adaptive response (AR) patterns.

Method

Thirty-one CLBP patients and 31 controls were tested on a free recall task with three word lists comprising pain words and neutral words. Further, the CLBP group was classified into patients with a FAR, ER and AR pattern, using a short screening including the Avoidance-Endurance Questionnaire (AEQ). Group differences with pain status (CLBP vs. healthy) and AEQ responses (FAR, ER, AR) as between-group factors, word type (pain vs. neutral) as within-group factor and free recall as dependent variable were analysed by means of repeated-measures analysis of (co-) variance.

Results

Results revealed different pain processing of pain words between FAR and ER patterns, whereas CLBP patients as a whole did not differ from the healthy controls. FAR patients displayed significantly less recall than ER patients.

Conclusion

Recall biases in CLBP patients are not only a result of experiencing pain but also effected by patients’ pain response pattern with respect to fear-avoidance versus endurance.

     

舒肝解郁胶囊与西酞普兰治疗女性首发轻、中度抑郁症患者的对照研究

目的探讨舒肝解郁胶囊治疗女性首发轻、中度抑郁障碍患者的治疗效果。方法研究组、对照组各30例女性首发轻、中度抑郁症患者,分别应用舒肝解郁胶囊和西酞普兰治疗。应用17项汉密尔顿抑郁评定量表(HAMD-17)和汉密尔顿焦虑评定量表(HAMA)评定疗效,应用副反应量表(TESS)评定分析不良反应。结果 HAMD-17和HAMA评分同组比较,治疗2周、4周、6周与治疗前相比均有统计学意义,差异非常显著(t=9.63~17.58,P0.01);两组间治疗前、治疗2周、4周、6周分别比较均无统计学意义(P0.05)。TESS统计研究组不良事件较对照组少。结论舒肝解郁胶囊治疗轻、中度抑郁症患者的疗效与西酞普兰相当,副反应较少。     

Chronic Mild Stress and Sucrose Consumption: Validity as a Model of Depression

Sucrose consumption and preference were examined in rats subjected to a 6-week regimen of unpredictable mild stressors, after Willner et al. [11]. These subjects were compared with groups exposed to: 1. only the food deprivation element of the stress protocol; or 2. the stress protocol without the food deprivation element. A control group was not exposed to stressors. Body weight and sucrose consumption were significantly reduced in stressed and food-deprived animals compared to the other 2 groups. These variables therefore appeared dependent on food deprivation and independent of other elements of the stress protocol. Neither sucrose consumption per gram body weight nor sucrose preference differed significantly among the 4 groups. These results indicate that food deprivation is not only necessary, but sufficient, to produce sucrose consumption deficits in rats. It is, therefore, likely that reduced sucrose consumption in stressed rats results solely from diminished body weight rather than exposure to the series of stressors. We conclude that sucrose consumption is not a valid index of reward responsiveness. Other measures (such as place-preference conditioning or intracranial self-stimulation threshold) should be evaluated also with respect to body weight change when considering the validity of stressor-based models of depressive disorder.     

Attentional Strategy Moderates Effects of Pain Catastrophizing on Symptom-Specific Physiological Responses in Chronic Low Back Pain Patients

In the present study, we examined whether experimentally-manipulated attentional strategies moderated relations between pain catastrophizing and symptom-specific physiological responses to a cold-pressor task among sixty-eight chronic low back patients. Patients completed measures of pain catastrophizing and depression, and were randomly assigned to sensory focus, distraction or suppression conditions during a cold pressor. Lumbar paraspinal and trapezius EMG, and cardiovascular responses to the cold pressor were assessed. Attentional strategies moderated the relation between pain catastrophizing and lumbar paraspinal muscle, but not trapezius muscle or cardiovascular responses. Only for participants in the suppression condition was catastrophizing related significantly to lumbar paraspinal muscle responses. Depressed affect did not account for this relation. These findings indicate that ‘symptom-specific’ responses among pain catastrophizers with chronic low back depend on how they attend to pain-related information. Specifically, it appears that efforts to suppress awareness of pain exaggerate muscular responses near the site of injury.     

Anger Management Style and Hostility: Predicting Symptom-Specific Physiological Reactivity Among Chronic Low Back Pain Patients

It was hypothesized that anger management style (anger-in or anger-out) and hostility affect the aggravation of chronic low back pain (CLBP) through symptom-specific (i.e., lower paraspinal muscle) reactivity during stress. Subjects were 102 CLBP patients who performed mental arithmetic and an Anger Recall Interview (ARI) while trapezius and lower paraspinal EMG, SBP, DBP, and HR were recorded. Results showed anger-in × hostility and anger-out × gender interactions for lower paraspinal but not trapezius reactivity, and only during the ARI. Further analyses revealed that (1) hostility was related positively to lower paraspinal reactivity among high anger suppressors, (2) hostility was related negatively to lower paraspinal reactivity among low anger suppressors, and (3) anger expression was related positively to lower paraspinal reactivity only among men. Anger management style and hostility may contribute to the exacerbation of CLBP by influencing stress reactivity only in muscles near the site of pain or injury.     

6-Month Results of Transdiscal Biacuplasty on Patients with Discogenic Low Back Pain: Preliminary Findings

Study Design: Prospective observational study.Objective: Our aim is to investigate the efficacy and safety of TransDiscal Biacuplasty.Summary of Background Data: Chronic discogenic pain is one of the leading causes of low back pain; however, the condition is not helped by most non-invasive methods. The results of major surgical operations for these patients are unsatisfactory. Recently, attention has shifted to disk heating methods for treatment. TransDiscal Biacuplasty is one of the minimally invasive treatment methods. The method was developed as an alternative to spinal surgical practices and Intradiscal Electrothermal Therapy for treatment of patients with chronic discogenic pain.Methods: The candidates for this study were patients with chronic discogenic pain that did not respond to conservative treatment. The main criteria for inclusion were: the existence of axial low back pain present for 6 months; disc degeneration or internal disc disruption at a minimum of one level, and maximum of two levels, in MR imaging; and positive discography. Physical function was assessed using the Oswestry Disability Index when measuring the pain with VAS. Patient satisfaction was evaluated using a 4-grade scale. Follow-ups were made 1, 3, and 6 months after treatment.Results: 15 patients were treated at one or two levels. The mean patient age was 43.1±9.2 years. We found the mean symptom duration to be 40.5±45.7 months. At the sixth month, 57.1% of patients reported a 50% or more reduction in pain, while 78.6% of patients reported a reduction of at least two points in their VAS values. In the final check, 78.6% of patients reported a 10-point improvement in their Oswestry Disability scores compared to the initial values. No complications were observed in any of the patients.Conclusions: TransDiscal Biacuplasty is an effective and safe method.     

Lower Extremity Fatigue,Sex, and Landing Performance in a Population With Recurrent Low Back Pain

Context:Low back pain and lower extremity injuries affect athletes of all ages. Previous authors have linked a history of low back pain with lower extremity injuries. Fatigue is a risk factor for lower extremity injuries, some of which are known to affect female athletes more often than their male counterparts.Objective:To determine the effects of lower extremity fatigue and sex on knee mechanics, neuromuscular control, and ground reaction force during landing in people with recurrent low back pain (LBP).Design:Cross-sectional study.Setting:A clinical biomechanics laboratory.Intervention(s):Fatigue was induced using a submaximal free-weight squat protocol with 15% body weight until task failure was achieved.Results:Fatigue altered landing mechanics, with differences in landing performance between sexes. Women tended to have greater knee-flexion angle at initial contact, greater maximum knee internal-rotation angle, greater maximum knee-flexion moment, smaller knee-adduction moment, smaller ankle-inversion moment, smaller ground reaction force impact, and earlier multifidus activation. In men and women, fatigue produced a smaller knee-abduction angle at initial contact, greater maximum knee-flexion moment, and delays in semitendinosus, multifidus, gluteus maximus, and rectus femoris activation.Conclusions:Our results provide evidence that during a fatigued 0.30-m landing sequence, women who suffered from recurrent LBP landed differently than did men with recurrent LBP, which may increase women''s exposure to biomechanical factors that can contribute to lower extremity injury.Key Words: clinical biomechanics, rehabilitation, female athletes, anterior cruciate ligament injuries

Key Points

• Sex differences in landing mechanics (fatigued and unfatigued) and neuromuscular control in men and women with recurrent low back pain are similar to the sex differences seen in individuals without a history of low back pain.
• Women experienced a greater knee-flexion angle at initial contact and maximum knee internal rotation, greater maximum knee-flexion moment, smaller maximum knee-adduction and ankle-inversion moments, smaller ground reaction forces at impact, and earlier multifidus activation.
• Reduced knee abduction at initial contact, increased maximum knee-flexion moment, and delayed activation of the semitendinosus, multifidus, gluteus maximus, and rectus femoris muscles were found in both men and women when landing after lower extremity fatigue.
• These changes are consistent with an increased risk of lower extremity injury for women, particularly when landing while fatigued.

Low back pain is a common occurrence in athletes. Estimates of the incidence vary, depending on the sport but range from 10% to 80%.¹ Despite apparent advances in the diagnosis and management of low back pain (LBP), this disorder continues to place a large burden on individuals and society.² Similarly, injuries to the lower extremity frequently affect athletes of all ages, accounting for approximately 53% of all injuries in collegiate athletes.³ Recognizing those at increased risk for back and lower extremity injury and discovering interventions that may reduce that risk are important research goals.Recently, authors^4–8 have proposed a neuromuscular model linking the function of the low back and the lower limbs. Alterations in the operation of this kinetic chain linkage proximally may increase injury risk at more distal regions. Because pelvic stability is influenced by activity of the trunk muscles through their attachments to the pelvis, an inability to properly activate those muscles may create an unstable pelvic base and contribute to altered lower extremity neuromuscular control. Previous studies have shown that activation of the trunk musculature affects lower extremity mechanics. For example, activation of the transversus abdominis significantly decreases activity of the lumbar erector spinae muscles, increases activity of the gluteus maximus and medial hamstrings, and decreases anterior pelvic tilt during prone active hip extension.⁹Trunk-muscle function is altered in LBP sufferers.¹⁰ Therefore, those individuals may not be able to produce sufficient pelvic stability to provide a stable base for lower extremity motion and control. The relationship between LBP and altered lower extremity movement control has been observed in several studies. Individuals with LBP have diminished lower extremity strength, flexibility, and range of motion,^11–13 as well as altered lower extremity biomechanics and neuromuscular control.^14,15 Those changes may increase the risk of lower extremity injury.Authors of prospective clinical studies have linked LBP history with lower extremity injuries. Zazulak et al¹⁶ found that a history of LBP was a significant predictor of knee injury in females and knee-ligament injury in males. Nadler et al¹³ observed that athletes with a history of lower extremity overuse or ligamentous injury were more likely to be treated for LBP during the following year. Additionally, football players with 2 or more of 3 risk factors (trunk-flexion–hold times of less than the median for the team, Oswestry Disability Index scores of 6 or more, or wall–sit-hold times of less than the median for the team) related to low back dysfunction and trunk-muscle endurance were at twice the risk for back and lower extremity injuries than were those with fewer than 2 factors.¹⁷Female athletes are up to 8 times more likely than male athletes to experience an anterior cruciate ligament (ACL) injury and are more prone to injuries from noncontact mechanisms.^18,19 The higher risk for ACL rupture among female athletes has been explained by hormonal, mechanical, neuromuscular, skeletal, and genetic factors.²⁰ The increased incidence of knee-ligament injuries in female athletes is multifactorial; which factors are dominant is currently unknown.²¹ Although both intrinsic and extrinsic factors may contribute, the injury occurs during a loading event, which can be moderated by mechanical and neuromuscular factors.^19,22 Landing technique and neuromuscular function can be improved with training and may potentially reduce the risk of ACL injury.²² Previous investigators have suggested that an increase in quadriceps activation²⁰ and a discrepancy between quadriceps and hamstrings strength may contribute to ACL injuries.²³Female athletes are more likely to sustain certain lower extremity injuries, such as ACL tears. Additionally, females more often develop those injuries as a result of noncontact mechanisms,¹⁸ which may reflect a failure of neuromuscular control because the injury occurs during loading.^19,22 It is unknown whether the occurrence of LBP affects lower extremity biomechanical and neuromuscular responses differently in males versus females.The effects of fatigue on lower extremity control responses in people with recurrent LBP are unknown. Fatigue serves as a major risk factor for lower extremity injury by altering muscle shock-absorbing capacity and coordination of the locomotor system.²⁴ Fatigue can affect neuromuscular input and output pathways.²⁵ Neuromuscular alterations that occur during fatigue potentially increase the risk of injury,^22,23 and muscle fatigue has been linked to a variety of lower extremity injuries.^24–26 Previous researchers²³ have suggested that the order of muscle activation may not change during fatigue, but muscle premotor and reaction phases may be noticeably greater, suggesting a possible compromise in their protective role. Muscle fatigue moderates lower extremity muscle-activation patterns during landing by altering muscle-burst activation, duration, and intensity, as well as the ability of the lower extremity muscles to absorb repetitive shock or stress.^27–29The effects of sex and fatigue on performance and injury risk are well documented.^19,22–24 Recurrent LBP has been established in the literature as a significant predictor of lower extremity injury.^16,17 However, limited information is available on the effects of lower extremity fatigue and sex on lower extremity control during landing in people with recurrent LBP. The purpose of our study was to determine the effects of lower extremity fatigue and sex on knee mechanics, neuromuscular control, and ground reaction force (GRF) during landing in people with recurrent LBP.     

The Value of SPECT/CT in Localizing Pain Site and Prediction of Treatment Response in Patients with Chronic Low Back Pain

In many circumstances, causing sites of low back pain (LBP) cannot be determined only by anatomical imaging. Combined functional and morphological imaging such as bone scan with single-photon emission computed tomography/computed tomography (SPECT/CT) may be helpful in identifying active lesions. The purpose of this study was to evaluate the usefulness of bone SPECT/CT in localizing the pain site and the treatment of chronic LBP. One hundred seventy-five patients suffering from chronic LBP who underwent SPECT/CT were included, retrospectively. All of the patients received multiple general treatments according to the symptoms, and some of them underwent additional target-specific treatment based on SPECT/CT. Numerical rating scale (NRS) pain score was used to assess the pain intensity. Of 175 patients, 127 showed good response to the given therapies, while the rest did not. Overall, 79.4% of patients with definite active lesions showed good response. Patients with mild active or no lesions on SPECT/CT had relatively lower response rate of 63.0%. Good response was observed by the treatment with the guidance of active lesions identified on SPECT/CT. SPECT/CT could be useful in identifying active lesions in patients with chronic LBP and guiding the clinicians to use adequate treatment.

Graphical Abstract

相似文献   

Depression and the Ironic Effects of Thought Suppression: Therapeutic Strategies for Improving Mental Control

Research indicates that depressed individuals are especially likely to engage in thought suppression in an attempt to achieve mental control over the thoughts that threaten their emotional well-being. In this report, we examine the process and problems of thought suppression and offer several strategies designed to enhance mental control. Strategies that improve mental control increase the availability and accessibility of effective distractions and optimize mental resources. Mental control can also be improved by reducing the number of unwanted negative thoughts (e.g., via cognitive therapy) and by using alternative strategies to thought suppression (e.g., acceptance-based strategies). An understanding of the counterproductive aspects of thought suppression and the identification of more effective alternatives can offer new insights into the cognitive factors that may contribute to depression and those that help to alleviate it.     

Low Back Pain in Adolescents: A Comparison of Clinical Outcomes in Sports Participants and Nonparticipants

Context:

Back pain is common in adolescents. Participation in sports has been identified as a risk factor for the development of back pain in adolescents, but the influence of sports participation on treatment outcomes in adolescents has not been adequately examined.

Objective:

To examine the clinical outcomes of rehabilitation for adolescents with low back pain (LBP) and to evaluate the influence of sports participation on outcomes.

Design:

Observational study.

Setting:

Outpatient physical therapy clinics.

Patients or Other Participants:

Fifty-eight adolescents (age  =  15.40 ± 1.44 years; 56.90% female) with LBP referred for treatment. Twenty-three patients (39.66%) had developed back pain from sports participation.

Intervention(s):

Patients completed the Modified Oswestry Disability Questionnaire and numeric pain rating before and after treatment. Treatment duration and content were at the clinician''s discretion. Adolescents were categorized as sports participants if the onset of back pain was linked to organized sports. Additional data collected included diagnostic imaging before referral, clinical characteristics, and medical diagnosis.

Main Outcome Measure(s):

Baseline characteristics were compared based on sports participation. The influence of sports participation on outcomes was examined using a repeated-measures analysis of covariance with the Oswestry and pain scores as dependent variables. The number of sessions and duration of care were compared using t tests.

Results:

Many adolescents with LBP receiving outpatient physical therapy treatment were involved in sports and cited sports participation as a causative factor for their LBP. Some differences in baseline characteristics and clinical treatment outcomes were noted between sports participants and nonparticipants. Sports participants were more likely to undergo magnetic resonance imaging before referral (P  =  .013), attended more sessions (mean difference  =  1.40, 95% confidence interval [CI]  =  0.21, 2.59, P  =  .022) over a longer duration (mean difference  =  12.44 days, 95% CI  =  1.28, 23.10, P  =  .024), and experienced less improvement in disability (mean Oswestry difference  =  6.66, 95% CI  =  0.53, 12.78, P  =  .048) than nonparticipants. Overall, the pattern of clinical outcomes in this sample of adolescents with LBP was similar to that of adults with LBP.

Conclusions:

Adolescents with LBP due to sports participation received more treatment but experienced less improvement in disability than nonparticipants. This may indicate a worse prognosis for sports participants. Further research is required.