Negative beliefs about low back pain are associated with high pain intensity and high level disability in community-based women

Background  

Although previous studies have investigated beliefs about back pain in clinical and employed populations, there is a paucity of data examining the beliefs of the broader community. We aimed to characterize the beliefs that community-dwelling women have about back pain and its consequences, and to determine whether those with varying levels of pain intensity and disability differ in their beliefs.     

Predictors of low back pain disability

Low back pain has major socioeconomic implications; much of the costs relate to disability and compensation. Theoretically, the early identification of patients at risk to become disabled from a low back episode would lead to more aggressive intervention and reduction of subsequent disability. Low back disability is related to occupational, psychosocial, diagnostic, demographic, anthropometric, health behavior, and injury factors that have been reported in the literature. The multiattribute utility model is a new experimental approach to prediction of disability. The relative weights of the various factors that might be predictive of low back disability are determined by a panel of experts. Although this model is not yet scientifically proven, it offers a promising method of answering the question, "Can low back disability be predicted?"     

Use of healthcare resources in patients with low back pain and comorbid depression or anxiety

Background ContextPsychological comorbidities are important prognostic factors for low back pain (LBP). To develop improved treatment paradigms, it is first necessary to characterize and determine current patterns of treatment in this population.PurposeIdentify how comorbid depression or anxiety in patients with LBP is related to use of healthcare resources.Study Design/SettingRetrospective cohort study using electronic health records from outpatient offices at a large multisite academic medical center.Patient SampleData from 513,088 unique patients seen between January 2010 and July 2020 (58.0% female, 52.6±19.5 years) with a diagnosis of LBP, indicated by predetermined ICD-9 and ICD-10 codes.Outcome MeasuresAverage self-reported pain scores, absolute differences and unadjusted risk ratios to compare opioid use, emergency department visits, hospitalizations, advanced imaging orders, spinal injections, and back surgeries between cohorts.MethodsClinical characteristics and data regarding use of healthcare resources were extracted from the electronic health record. Clinical features and patterns in healthcare utilization were determined for patients with depression or anxiety compared to those without.ResultsDepression or anxiety was coded for 21.4% of patients at first LBP visit. Those with depression or anxiety were more likely to be on opioids (unadjusted risk ratio: 1.22, CI: [1.22,1.23]), go to the emergency department (1.31 [1.30–1.33]), be hospitalized (1.15 [1.13, 1.17]), receive advanced imaging (1.09 [1.08, 1.11]), receive an epidural steroid injection (1.16 [1.15, 1.18]), and less likely to have back surgery (0.74 [0.72, 0.77]). Differences in pain scores for those with depression/anxiety compared to those without were not clinically significant.ConclusionsDepression/anxiety is associated with increased use of healthcare resources, and is not associated with clinically meaningful elevated pain scores. Limitations come from use of an aggregate data set and reliance on administrative coding.     

Low pressure pain thresholds are associated with, but does not predispose for, low back pain

Chronic pain is often associated with hyperalgesia in cross-sectional studies. In the present study, a random cohort of 40-year-old individuals (n = 264) from the general population was assessed for low back pain (LBP) status and pressure pain threshold (PPT), with follow-up assessment 4 and 8 years later. Low PPT at baseline as a potential risk factor for the development of LBP was investigated longitudinally and the association between LBP and hyperalgesia was studied cross-sectionally at baseline and 8-year follow-up. Generalized (p  < 0.03) and localized pressure hyperalgesia (p < 0.02) was found in participants with long-lasting LBP, but not with recent LBP (p > 0.08). Of the participants without recent or long-lasting LBP, those with a low PPT at baseline (lower 10% percentile) had no increased risk of developing LBP (p > 0.05). The findings indicate that PPT decreases as a consequence of long-lasting pain, whereas a low PPT seems not to constitute a separate risk factor for the development of LBP.     

Fear of movement is not associated with trunk movement variability during gait in patients with low back pain

BACKGROUNDLiterature describing differences in motor control between low back pain (LBP) patients and healthy controls is very inconsistent, which may be an indication for the existence of subgroups. Pain-related psychological factors might play a role causing these differences.PURPOSETo examine the relation between fear of movement and variability of kinematics and muscle activation during gait in LBP patients.STUDY DESIGNCross-sectional experimental design.PATIENT SAMPLEThirty-one Chinese LBP patients.OUTCOME MEASURESSelf-report measures: Visual Analog Score for pain; TAMPA-score; Physiologic measures: electromyography, range of motion.FUNCTIONAL MEASURESLBP history; the physical load of profession, physical activity.METHODSPatients were divided in high and low fear of movement groups. Participants walked on a treadmill at four speeds: very slow, slow, preferred and fast. Kinematics of the thorax and the pelvis were recorded, together with the electromyography of five bilateral trunk muscle pairs. Kinematic and electromyography data were analysed in terms of stride-to-stride pattern variability. Factor analysis was applied to assess interdependence of 11 variability measures. To test for differences between groups, a mixed-design multivariate analysis of variance was conducted.RESULTSKinematic variability and variability of muscle activation consistently loaded on different factors and thus represented different underlying variables. No significant Group effects on variability of kinematics and muscle activation were found (Hotelling's Trace F=0.237; 0.396, p=.959; .846, respectively). Speed significantly decreased kinematic variability and increased variability in muscle activation (Hotelling's Trace F=8.363; 4.595, p<.0001; <.0001, respectively). No significant interactions between Group and Speed were found (Hotelling's Trace F=0.204; 0.100, p=.762; .963, respectively).CONCLUSIONSThe results of this study do not support the hypothesis that variability in trunk kinematics and trunk muscle activation during gait in LBP patients are associated with fear of movement.     

Prevalence of low back pain and factors associated with chronic disabling back pain in Japan

Purpose

This study aimed to report lifetime and 4-week low back pain (LBP) prevalence and examine factors associated with chronic LBP and back pain disability over a lifetime in a Japanese adult population.

Methods

In February 2011, 1,063,083 adults aged 20–79 years registered as internet research volunteers were randomly selected to participate in a questionnaire survey. The data from 65,496 respondents were analyzed to calculate age-standardized lifetime and 4-week prevalence. Chronic LBP and back pain disability were defined as LBP lasting for ≥3 months and a consecutive ≥4-day-long absence, respectively. Factors associated with chronic disabling back pain over a lifetime were examined by multiple logistic regression modeling.

Results

The lifetime LBP prevalence was 83 % and 4-week prevalence was 36 %; majority of the respondents had disability-free LBP. Smoking [adjusted odds ratio (aOR): 1.17; 95 % CI: 1.05, 1.30], lower educational level (aOR: 1.21; 95 % CI: 1.09, 1.34), history of disabling back pain among family members and/or significant others (aOR: 1.46; 95 % CI: 1.27, 1.67), occupational LBP (aOR: 1.34; 95 % CI: 1.16, 1.55), traffic injury (aOR: 2.81; 95 % CI: 2.07, 3.81), compensated work injury (aOR: 2.42; 95 % CI: 1.92, 3.05), radiating pain (aOR: 4.94; 95 % CI: 4.45, 5.48), low back surgery (aOR: 10.69; 95 % CI: 9.02, 12.68), and advice to rest upon back pain consultation (aOR: 3.84; 95 % CI: 3.36, 4.40) were associated with chronic disabling back pain over a lifetime.

Conclusions

LBP is common in Japan as in other industrialized countries. The association between the advice to rest and chronic disabling back pain supports recent treatment guidelines emphasizing continuation of daily activities.     

Self-reported assessment of disability and performance-based assessment of disability are influenced by different patient characteristics in acute low back pain

For an individual, the functional consequences of an episode of low back pain is a key measure of their clinical status. Self-reported disability measures are commonly used to capture this component of the back pain experience. In non-acute low back pain there is some uncertainty of the validity of this approach. It appears that self-reported assessment of disability and direct measurements of functional status are only moderately related. In this cross-sectional study, we investigated this relationship in a sample of 94 acute low back pain patients. Both self-reported disability and a performance-based assessment of disability were assessed, along with extensive profiling of patient characteristics. Scale consistency of the performance-based assessment was investigated using Cronbach’s alpha, the relationship between self-reported and performance-based assessment of disability was investigated using Pearson’s correlation. The relationship between clinical profile and each of the disability measures were examined using Pearson’s correlations and multivariate linear regression. Our results demonstrate that the battery of tests used are internally reliable (Cronbach’s alpha = 0.86). We found only moderate correlations between the two disability measures (r = 0.471, p < 0.001). Self-reported disability was significantly correlated with symptom distribution, medication use, physical well-being, pain intensity, depression, somatic distress and anxiety. The only significant correlations with the performance-based measure were symptom distribution, physical well-being and pain intensity. In the multivariate analyses no psychological measure made a significant unique contribution to the prediction of the performance-based measure, whereas depression made a unique contribution to the prediction of the self-reported measure. Our results suggest that self-reported and performance-based assessments of disability are influenced by different patient characteristics. In particular, it appears self-reported measures of disability are more influenced by the patient’s psychological status than performance-based measures of disability.