Background & Aims

Chronic low back pain is a multidimensional experience that is most effectively understood through a biopsychosocial framework. Disability can be an outcome of chronic low back pain and varies based on biopsychosocial factors that go beyond pain intensity. There is inter-individual variability in terms of stress levels and across various pain-related psychosocial factors, such as pain catastrophizing. It is unclear whether distinct stress-related phenotypes are associated with disability. This study aimed to identify subgroups of individuals living with chronic low back pain based on general and pain-specific stress and psychological characteristics and examine their association with pain disability.

Methods

Participants living with chronic low back pain (n=205) completed self-reported questionnaires at baseline on stress (Perceived Stress Scale and Covid Stress Scale), pain appraisal (Pain Appraisal Inventory), pain catastrophizing (4-item Short-form of the Pain Catastrophizing Scale), pain self-efficacy (4-item Short-Form of the Pain Self-Efficacy Questionnaire), as well as depressive symptoms, pain interference, physical functioning, anxiety, and sleep using the NIH Minimal Dataset for Chronic Low Back Pain. The follow-up questionnaire three months later included a measure of pain disability (Oswestry Low Back Pain Disability Questionnaire). Data was analysed using partitioning cluster analysis and linear regression analysis.

Results

The sample included 58.3% of women and participants had an average age of 48.3 years (SD= 12.1). Three clusters were found; levels of both general and pain-related stress seem to match levels of general psychological distress. Cluster 1 regrouped participants reporting overall lower levels of stress and psychological distress and higher levels of self-efficacy. Cluster 2 regrouped participants with poorer psychological functioning, increased stress, and low self-efficacy. Participants in the third cluster reported average psychological distress and stress. Controlling for age and sex, the cluster membership was associated with pain disability (B=0.153, p < 0.05). Those with mild stress and psychological distress (OSW mean score=22.8, SD=10.7) had lower levels of pain disability three months later compared to those with heightened (OSW mean score=45.6, SD=17.5) and those with moderate levels of stress and psychological distress (OSW mean score=30.3, SD=12.3).

Conclusions

The data presented in this study suggest that general and pain-related stress may parallel levels of general psychological distress: this study identified a subgroup with poorer psychological functioning and increased stress that is associated with the worsening of pain disability three months later. Results are important in that they emphasize the role that stress can play in overall levels of psychological distress and pain-related disability. This should be considered an important treatment target to enhance people living with chronic low back pain’s comprehension of their stress vulnerability, their pain experience, and its effective management.

References

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Gatchel RJ, Turk DC. Psychological approaches to pain management. 1996. The Guilford Press.
Meints SM, Edwards RR. Evaluating psychosocial contributions to chronic pain outcomes. Prog Neuropsychopharmacol Biol Psychiatry. 2018;87(Pt B):168-182.
Pagé GM, Lacasse A, Beaudet N, Choinière M, Deslauriers S, Diatchenko L, et al. The Quebec Low Back Pain Study: a protocol for an innovative 2-tier provincial cohort. Pain Rep. 2020;5(1):e799.

Presenting Author

Karen Ghoussoub

Poster Authors

Karen Ghoussoub

M.Sc.

Université de Montréal

Lead Author

E-mail

Mael Gagnon-Mailhot

M.Sc.

Lead Author

E-mail

Élise Develay

Université de Montréal

Lead Author

E-mail

Sonia Lupien

Université de Montréal

Lead Author

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Pierre Rainville

Université de Montréal

Lead Author

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Mathieu Roy

Dept. of Psychology, McGill University, Montreal, Qc., Can., H3A 1G1

Lead Author

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E. Vachon-Presseau

McGill University

Lead Author

E-mail

Gabrielle Pagé

University of Montreal

Lead Author

E-mail

Topics

  • Mechanisms: Psychosocial and Biopsychosocial