Background & Aims
Low Back Pain (LBP) is the leading cause of years lived with disability and is recognized as a global public health issue. It is estimated that 40% of LBP people develop chronic symptoms. The management of chronic LBP has shifted from a biomedical to a Biopsychosocial (BPS) approach, a model that perceives pain as a multidimensional and dynamic interaction among biological, psychological and social factors. Despite being self-reported, pain severity remains the most evaluated outcome in scientific and clinical studies. Evidence suggests an association between pain severity and BPS factors. However, this association appears to be more complex in low- and middle-income countries, considering that pain is an individual experience and influenced by the context. The aim of this study is to analyze the association between BPS factors and pain severity in Brazilians with chronic LBP.
Methods
The cross-sectional study included 422 participants with chronic LBP aged 18 years or older. The participants were evaluated by the Movimento Project of the Department of Physiotherapy at the Federal University of Ceará, Brazil. The primary outcome was pain severity, measured by the Numerical Rating Pain Scale (0-10). Biological factors including sex, age, duration of pain, comorbidities, body mass index (BMI), and mobility (Anterior Trunk Flexion Test), psychological aspects including the fear of movement (Tampa Scale for Kinesiophobia), and social and lifestyle factors, including income, schooling, employment, marital status, smoking, alcoholism, number of pain medications, and level of physical activity and sedentary behavior (International Physical Activity Questionnaire – IPAQ). The univariate analysis preceded the linear and logistic regression analysis, which had pain severity as a dependent variable. We used the number of pain medications as the control variable.
Results
The majority of participants were female (75.8%) and with a mean age of 49.38 (± 16.55) years. The mean NRPS score was 5.05 (± 2.73), 53,1% reported mild to moderate pain, and 46.1% reported severe pain. The mean of number of pain medications was 0.98 (± 1.0). The severity of pain is associated with biological factors such as sex (95%CI= -1.40 to -0.19), BMI ( 95%CI= 0.16 to 0.12), and mobility (95%CI= 0.01 to 0.05), psychological factor such as fear of movement (95%CI= 0.02 to 0.08), and social and lifestyle factors such as income (95%CI= -1.33 to -0.90), schooling (95%CI= -1.33 to -0.28), and sedentary behavior (95% CI= -0.21 to -0.05). In the multivariate analysis, sedentary behavior (?=-0.11 ;p=0.012), BMI(?=0.07; p=0.008), and schooling (?=-0.07; p=0.023) are associated with severity of LBP (R2=0.12; p<0.0001; n=305). Greater severity of chronic low back pain was explained in a model that included females (OR=0.55) and lower schooling (OR=0.52) (X2=30.02; p<0.0001; R2=0.13).
Conclusions
The pain severity is associated with biopsychosocial factors in Brazilians with chronic LBP. The interaction between sedentary behavior, BMI, and schooling seems to be a way to explain the severity of pain. Social factors such as schooling have a greater influence on Brazilians with greater severity of chronic LBP.
References
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Presenting Author
Ana Carla Lima Nunes
Poster Authors
Ana Carla Lima Nunes
PhD
Universidade Federal do Ceará
Lead Author
Denis Maclean Cunha e Silva Júnior
Federal University of Ceara
Lead Author
Antonia Thais Guimarães Gomes
Federal University of Ceara
Lead Author
FABIANNA MORALEIDA
Universidade Federal do Ceara-Centro
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Low Back Pain