While back pain is a fairly common affliction, being disabled by back pain is comparatively rare. However, when a back pain-induced disability occurs, it results in a very restricted lifestyle, high treatment costs, and can often lead to relationship disruption, isolation and depression.

A number of studies have suggested that the severity of the medical condition, and the severity of the pain, do not correlate with the level of disability in some lower back pain patients.

Over the last ten years there has been a great deal of research looking at an individual’s perception of their condition and its influence on their disability. In this study, roughly 1500 patients were assessed across numerous primary and specialist care medical practices.

The authors looked at the duration of the patient’s back problem, the severity of their pain, relevant x-rays or scans, and their treatment history. They also noted whether the individual was eligible for worker’s compensation and whether they were experiencing “catastrophising”, or high levels of anxiety and fear about their condition.

The authors report that disability was more likely in people whose back pain was concurrent with leg pain.

Interestingly, the researchers found that catastrophising was a major factor associated with disability, and explained 28% of the cases of disability in the test subjects. This contrasts with what one might assume to be the more likely cause of disability, the reported severity of lower back pain, which explained only three percent of the cases.

This finding is in line with other studies, showing distress and worry about back pain increases the likelihood an individual will not return to work. It reinforces what are regarded to be the best practice treatment approaches – that is, a key factor in successful treatment is providing advice, explanations and reassurance to a patient in a way they understand.

Validating the patient’s problem, addressing their distress, educating them about their condition, comprehensive behaviour therapy, education on problem solving and brief intervention programs are all effective approaches in addressing distress and catastrophising.

Authors

Kovacs FM. Seco J. Royuela A. Pena A. & Muriel A. of the Spanish Back Pain Research Network.

Institution

Fundacion Kovacs, Palma de Mallorca, Spain. 

Title

The correlation between pain, catastrophizing, and disability in subacute and chronic low back pain: a study in the routine clinical practice of the Spanish National Health Service.

Source

Spine. 36(4):339-45, 2011 Feb 15.

Country of Publication

United States

Abstract

STUDY DESIGN: Correlation between variables measured with previously validated instruments.

OBJECTIVE: To explore the association between catastrophizing and disability in patients treated for subacute or chronic low back pain (LBP) within routine clinical practice in Spain.

SUMMARY OF BACKGROUND DATA: The influence of psychological variables on LBP-related disability in Southern Europe is different to the one in the Anglo-Saxon and Northern European cultural environments. In Spanish LBP patients, the influence of fear avoidance beliefs on disability is negligible, and catastrophizing does not mediate the improvement of disability caused by active education. The association between catastrophizing and dis-ability is unknown.

METHODS: Thirty-three clinicians working for the Spanish National Health Service in 6 primary care and 8 specialty centers, recruited 1461 patients seeking care for subacute and chronic LBP. Patients were assessed only once. A linear regression model was developed to assess the percentage of the variance of disability explained by gender, age, chronicity status, severity of LBP, severity of referred pain (referred pain down to the leg), catastrophizing, eligible for workers' compensation (yes/no), failed back surgery (yes/no), radiologic findings, and treatments.

RESULTS: Correlations among LBP, referred pain down to the leg, disability, and catastrophizing were moderate, but significant. The strongest one was between disability and catastrophizing (r 0.520). Catastrophizing explained 28% of disability, whereas severity of LBP only 3%. Global adjusted R of the model was 0.387. There was an association between some radiologic findings and treatments, and slightly higher levels of disability.

CONCLUSION: In Southern European subacute and chronic LBP patients, catastrophizing correlates with dis-ability and explains approximately one-fourth of its variance. Further studies should assess its value as a prognostic factor in subacute and chronic patients.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/20823782