Background & Aims
Low-Back Pain (LBP) is the leading cause of disability for individuals and societies worldwide[1]. Most prior work examining predictors of chronic pain impact is primarily limited to biological and psychological factors. A better understanding of social risk factors for LBP can help improve effectiveness and equity of LBP interventions. The aim of this study is to characterize social factors, sleep, and pain among participants of a community-based pilot study of adults with acute LBP, with a focus on perceived community control2. Ultimately, this research is part of the foundation for a pain equity program with the objective of building community empowerment and reducing the burden of pain for all people.
Methods
A community-based convenience sample was recruited from Durham and Kannapolis, NC, USA, between February-November 2022, and followed-up at 3 months. Eligibility criteria: Non-pregnant adults aged 18+ with acute LBP (<4 weeks at screening and ?30 days without LBP before onset) without systemic inflammatory or autoimmune conditions, non-skin cancer, spine/low-back surgery or trauma, and spinal defects. We used descriptive statistics to characterize social factors, sleep, and pain, overall and by levels of perceived community control[2]. Social factors included age, sex assigned at birth, self-reported race, socioeconomic position (education, insurance, financial wellbeing). Sleep was measured by the Pittsburgh Sleep Quality Index (PSQI[3]). Pain measures were pain intensity, pain interference, and PEG scale4 at baseline and follow-up, baseline bothersome pains, and transition to chronic LBP at 3 months. Perceived individual and community control were measured per Israel et al., 1994[2].
Results
Of 131 adults with acute LBP, 110 had data on perceived community control (5 items, 5-25 total score, each scored 1-5 where 1=strongly agree and 5=strongly disagree and lower scores meaning higher control; Cronbach’s alpha=0.71, 95%CI 0.62, 0.78). Overall, median (interquartile range [IQR]) perceived community control was 14 (11,15), with 40 adults (36%) with “low control” (scores ?15 score), 58 (53%) with “medium control” (scores 10-14), and 12 (11%) with “high control” (scores 5-9). The overall sample predominantly reported White race (89, 68%) and higher socioeconomic position (e.g., 7% with >than high school [HS]/HS diploma/GED, 8% “just meet basic expenses”, 8% uninsured). People with high perceived community control also had, on average, higher perceived individual control, better perceived neighborhood walkability, lower number of sites with bothersome comorbid pain, higher sleep quality, and higher proportion with male sex, White race, and higher socioeconomic position.
Conclusions
Community-based research with an equity focus may need to include active recruitment outreach to include a higher proportion of participants with minoritized race, ethnicity, and lower income. Higher community control should be further explored (e.g., community level measure, reference values in other populations, other instruments) as a potentially modifiable social construct that may help to reduce pain impact.
References
1. GBD Collaborators, LBP (2023). “Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021.” Lancet Rheumatol 5(6): e316-e329.
2. Israel, B. A., et al. (1994). “Health education and community empowerment: conceptualizing and measuring perceptions of individual, organizational, and community control.” Health Educ Q 21(2): 149-170.
3. Buysse, D. J., et al. (1989). “The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research.” Psychiatry Res 28(2): 193-213.
4. Krebs, E. E., et al. (2009). “Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference.” J Gen Intern Med 24(6): 733-738.
Presenting Author
Flavia P. Kapos
Poster Authors
Topics
- Access to Care