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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4.DELGADO-SANCHEZ, A. et al. Are We Any Closer to Understanding How Chronic Pain Develops? A Systematic Search and Critical Narrative Review of Existing Chronic Pain Vulnerability Models. Journal of pain research, v. 16, p. 3145–3166, 2023.
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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