The effect of social support in chronic back pain: number of treatment sessions and reported level of disability

Fatigue and Depressive Mood in Chronic Low Back Pain

PURPOSE

Fatigue is prevalent, problematic, and co-occurs in chronic low back pain. When left untreated, fatigue can increase depressive mood, and intensify pain burden and disability in patients with chronic low back pain. The purpose of this study was to examine the relationship of fatigue to depressive mood, pain severity, and pain interference in patients with chronic low back pain.

DESIGN AND METHODS

A cross-sectional design was used to enroll and evaluate adults (n = 67) with chronic low back pain (>6 months) during their visit to an outpatient pain clinic. Participants completed psychometric instruments for fatigue, depressive mood, pain severity, and pain interference.

RESULTS

Participants were primarily women (73%), White (59%), with a median age of 59 years (range 22-70 years). Multiple regression models showed significant positive associations between fatigue and depressive mood (SD: 0.025 p = 0.017) with a coefficient of 0.069; fatigue and pain interference (SD: 0.123 p = 0.010) with a coefficient of 0.652; fatigue and pain severity (SD: 0.125 p-value <0.05) with a coefficient of 0.359. After adjusting for demographic factors (age, sex, and race/ethnicity) the associations remained significant.

CONCLUSIONS

The findings suggest that fatigue is associated with greater depressive mood, pain severity, and pain interference in adults with chronic low back pain.

CLINICAL IMPLICATIONS

Assessing the extent of fatigue and depressive mood as part of pain management may benefit patients with chronic low back, thereby reducing symptom burden.

The predicting factors of chronic pain among nursing students: a national study in Iran

BACKGROUND

Nursing students are faced with a variety of challenges that demand effective cognitive and emotional resources. The physical and psychological well-being of the students plays a key part in the public health of the community. Despite the special lifestyle of nursing students, few studies have addressed chronic pain in this population. Accordingly, the present study aims to identify the predictors of chronic pain among nursing students.

METHODS

This cross-sectional study was conducted on 1,719 nursing students aged 18-42 years, between February and November 2019. Sampling was carried out in several stages. Data were collected using seven instruments, namely a demographics survey, the characteristics of chronic pain form, Spielberger State-Trait Anxiety Inventory (STAI), the Patient Health Questionnaire-9 (PHQ-9), the Bar-on Emotional Quotient Inventory, Academic Satisfaction Scale, and Procidano and Heller Social Support Scale. Descriptive statistics, multinomial logistic regression, and regression models were used to describe the characteristics of the pain and its predictive factors.

RESULTS

The average age of the participants was 22.4 ± 2.96 years. The results of univariate analysis showed that gender (P = 0.506), mother's education (P = 0.056, P = 0.278, P = 0.278), father's education (P = 0.817, P = 0.597, P = 0.41), place of residence (P = 0.215), depression (P = 0.501), grade point average (P = 0.488), academic satisfaction (P = 0.183) and chronic pain weren't significantly correlated with chronic pain in nursing students. The results of the multiple logistic regression models showed that chronic pain was positively correlated with age, social support, state anxiety, and trait anxiety (OR = 1.07, 95% CI: 1.02-1.12; OR = 0.95, 95% CI: 0.93-0.97; OR = 1.03, 95% CI: 1.02-1.05; and OR = 1.97, 95% CI: 0.95-1.99; respectively).

CONCLUSION

The prevalence of chronic pain was relatively high in these students. In addition, age, social support, and anxiety could be important factors in the development or persistence of chronic pain in nursing students. The results also provided basic and essential information about the contributing factors in this area. However, consideration of factors such as referral for treatment, home medications for pain relief, and outcomes of chronic pain are suggested in future longitudinal studies.

Associations Between Adult Attachment, Pain Catastrophizing, Psychological Inflexibility and Disability in Adults with Chronic Pain

We investigated whether attachment insecurity (anxiety and avoidance) moderated the association between satisfaction with social support and pain disability. We also tested whether the relationship between insecure attachment and pain disability was serially mediated by pain catastrophising and psychological inflexibility. A large-scale cross-sectional correlational design was employed. Data were collected using an online survey. Correlation, serial mediation and moderated regression analyses were used. Data from 894 people with self-reported chronic pain were analysed. Based on correlations, age, depression, and pain intensity were included as covariates. No direct effect of satisfaction with social support on pain disability was observed in the moderation. Attachment anxiety was positively associated with pain disability (b = 1.20, t = 2.03, p < .05), but attachment avoidance was not (b = -0.08, t = -0.13, p = .90). The association between attachment anxiety and pain disability was partially mediated by pain catastrophising and psychological inflexibility (c = 1.21, t = 4.37, p < .001; a1db2 = 0.33, t = 5.15, p < .001). The relationship between attachment avoidance and pain disability was fully mediated by pain catastrophising and psychological inflexibility (c = 0.15, t = 0.54, p = .59; a1db2 = 0.13, t = 2.24, p < .05). This study provided initial evidence that pain catastrophising and psychological inflexibility mediate the association between insecure attachment and pain disability. Follow-up research using a longitudinal design is recommended.

Are We Any Closer to Understanding How Chronic Pain Develops? A Systematic Search and Critical Narrative Review of Existing Chronic Pain Vulnerability Models

Identifying biopsychosocial factors underlying chronic pain vulnerability is essential for the design of preventative efforts. Multiple chronic pain vulnerability models exist, however, there is a lack of comprehensive evaluation of these models in the literature, potentially due to the lack of guidelines that specify the criteria by which these types of work should be assessed. In this work, we created evaluation criteria (based on the general goals of conceptual models), and we then used them to critically review the chronic pain vulnerability models available in the current peer-reviewed literature (identified through a systematic search). Particularly, we evaluated the models on the basis of conceptual clarity/specificity of measures, depth of description of aetiological and mechanistic factors, use of a whole system approach, and quality of the evidence associated with the models. We found nine conceptual models that have been explored in detail (eg, fear avoidance model, diathesis-stress model). These models excel at clarity and are supported mostly by self-report evidence of a psychological nature (anxiety sensitivity, pain catastrophizing, etc.), but provide little explanation of mechanistic and aetiological factors. In the future, models could be improved by complementing them with proposals from other models and exploring potential causal factors and mechanisms maintaining the condition. This task could be carried out through prospective cohort studies, and computational approaches, amongst others.

Examining Physical and Cognitive Function in Chronic Low Back Pain Through the Use of a Multisystem Resilience Framework

OBJECTIVES

Chronic pain results in significant impairment in older adults, yet some individuals maintain adaptive functioning. Limited research has considered the role of positive resources in promoting resilience among older adults. Likewise, these factors have largely been examined independently. We aimed to identify resilience domains based on biopsychosocial factors and explore whether resilience phenotypes vary across sleep disturbance, fatigue, and cognitive function.

METHODS

Sixty adults (ages ≥60 years) with chronic low back pain completed measures of psychological, health, and social functioning. On the basis of previously published analyses, principal-components analysis was conducted to create composite domains for these measures, followed by cluster analysis to identify phenotypes.

RESULTS

Four profiles emerged: Cluster 1, with high levels of psychosocial and health-related functioning; Cluster 2, with high health-related functioning and low psychosocial functioning; Cluster 3, with high psychosocial functioning and poorer health; and Cluster 4, with low levels of functioning across all domains. Significant differences across cluster membership emerged for sleep disturbance (ηp2 = 0.29), fatigue (ηp2 = 0.29), and cognitive abilities (ηp2 = 0.47). Individuals with the highest levels of resilience demonstrated more optimal outcomes in sleep and fatigue (P values ≤0.001) than did individuals with a less resilient phenotype. Furthermore, the High-Resilience group (Cluster 1) and the High Psychosocial / Low Health group (Cluster 3) had lower cognitive impairment than did the High Health / Low Psychosocial group (Cluster 2) and the Low-Resilience group (Cluster 4) (P values ≤0.009).

CONCLUSIONS

A higher array of protective resources could buffer against the negative sequelae associated with chronic low back pain. These exploratory findings support the multidimensional nature of resilience and suggest that targeting resilience from a multisystem perspective might help to optimize interventions for older adults with chronic pain.

Describing the nonsurgical, nonpharmacological interventions offered to adolescents with persistent back pain in randomized trials: A scoping review

BACKGROUND AND OBJECTIVES

Persistent nonspecific back pain is now established as a biopsychosocial phenomenon that can be meaningfully affected by individuals' cognitions, emotions, lifestyle factors and family and social relationships. Recent guidelines for the treatment of adolescents with persistent nonspecific back pain, as well as those for youth with mixed chronic pain, strongly recommend interdisciplinary care in which adolescents receive treatment for both mind and body. The objective of this scoping review was to examine the interventions evaluated in randomized trials for adolescents with persistent back pain to determine whether they correspond to these guidelines and to reveal future research priorities.

DATABASES AND DATA TREATMENT

The review protocol was registered in March 2022. We followed the PRISMA guidelines for scoping reviews. Twelve electronic databases were searched for relevant study reports. Data were charted on study characteristics, participant characteristics and intervention details using the Template for Intervention Description and Replication (TIDieR) checklist.

RESULTS

The search yielded 1952 records, of which eight reports representing seven randomized trials were eligible. The most common interventions were exercise therapy (n = 6) and back education (n = 4). Five studies employed multiple intervention components, but none was multidisciplinary. Studies primarily targeted posture or biomechanical factors. One study included an intervention addressing participants' fears and beliefs about pain.

CONCLUSIONS

Randomized trials for adolescents with persistent back pain have primarily relied upon an outdated, biomechanical explanation of persisting pain. Future randomized trials should align with current treatment recommendations and measure outcomes across multiple biopsychosocial domains.

SIGNIFICANCE

This scoping review describes in detail the interventions included in randomized trials for adolescents with persistent, nonspecific back pain. The review is important because it reveals discrepancies between those interventions and the interventions recommended for this population.

Contemporary management of pain in cirrhosis: Toward precision therapy for pain

Chronic pain is highly prevalent in patients with cirrhosis and is associated with poor health-related quality of life and poor functional status. However, there is limited guidance on appropriate pain management in this population, and pharmacologic treatment can be harmful, leading to adverse outcomes, such as gastrointestinal bleeding, renal injury, falls, and hepatic encephalopathy. Chronic pain can be categorized mechanistically into three pain types: nociceptive, neuropathic, and nociplastic, each responsive to different therapies. By discussing the identification, etiology, and treatment of these three mechanistic pain descriptors with a focus on specific challenges in patients with cirrhosis, we provide a framework for better tailoring treatments, including nonpharmacologic therapies, to patients' needs.

Patient adherence to physical activity advice (PAPA) in patients with low back pain: Study protocol for a multicentre randomized controlled trial

BACKGROUND

It seems that nonspecific low back pain (NSLBP) cannot be successfully treated with a single intervention of any kind. However, a positive effect of an active lifestyle including physical activities in NSLBP is reported on pain and disability. Advising regular physical activity is one of the mainstays in physical therapy treatment, appealing to patients' adherence. Many patients with low back pain do not seem to adhere to their physiotherapist's advice. In this study, the influence of social support on adherence to an activity advice will be investigated.

OBJECTIVE

Objective of the study is to investigate if patients with low back pain randomised to receive social support adhere better to an activity advice than patients randomised to the control group.

METHODS

In a randomized controlled clinical trial, in private physiotherapy practices in the Netherlands, patients ≥18 years presenting with at least a second episode of nonspecific low back pain will be randomized over two groups: activity advice and social support as an add-on to usual care versus usual care alone. The primary outcome measure is adherence to an activity advice measured by an activity monitor at 1, 6 and 12 weeks. All other objectives will be measured by questionnaires.

DISCUSSION

This project is the first comprehensive research project to assess whether social support influences adherence to an activity advice outside the clinical setting without supervision of a healthcare provider. Where evidence of influence on social support is lacking, findings may have implications for the management of patients with low back pain. In addition, findings may enable physiotherapists to predict in which patients with low back pain an activity advice with social support makes sense.

CLINICALTRIAL

GOV: NCT02996955.

Negative impact of chronic pain: The role of locus of control and perceived family validation of chronic pain

The present study investigates how participants' locus of control and their family and friends' validation of their pain influences participants' chronic pain experiences. Four thousand, 25 adults were recruited through the Chronic Pain In America survey. Results show that individuals who endorse an internal locus of control and experience family and friends' validation of their chronic pain reported better chronic pain outcomes and less negative life impact due to chronic pain. The current results indicate the locus of control and family and friends' validation of chronic pain experience plays an important role in chronic pain and the impact of chronic pain across the life course.

Significant other interactions in people with chronic low back pain: Subgrouping and multidimensional profiles

Background: Back pain is complex. Social support and significant other interactions influence the pain experience. Purpose: To statistically derive subgroups of people with chronic low back pain based upon their interactions with significant others, and profile subgroups across multidimensional variables. Research Design: Longitudinal cohort study. Study Sample: People with chronic axial low back pain ( n = 262). Data Collection and Analysis: Latent class analysis of significant other interaction data was used to derive subgroups of people with chronic low back pain. Subgroups were profiled across baseline multidimensional variables and one-year follow-up pain intensity, disability and bothersomeness. Results: Three clusters were identified: Cluster 1 (7.6%) characterised by the lowest distracting, punishing and solicitous interactions. Cluster 2 (16.0%) characterised by the highest distracting and solicitous responses and social support. Cluster 3 (76.3%) characterised by the highest punishing and lowest social support. Cluster 1 reported less disability than Clusters 2 and 3. Mindfulness was significantly different across all subgroups with Cluster 1 being most mindful and Cluster 3 least mindful. Depression, anxiety and stress were significantly higher in Cluster 3 than Cluster 1. Pain catastrophising was higher for Cluster 2 than Clusters 1 and 3. Cluster 2 had lower pressure pain threshold than Clusters 1 and 3. Conclusions: These results support the association between significant other interactions and the experience of back pain. Considering significant other interactions in clinical practice may be important for managing some people’s presentation.

Chronic pain and masculine identity: life-world interviews with men at a South African Pain Clinic

PURPOSE

The purpose was to investigate experiences of men who were living with chronic pain in relation to masculine identity and their experiences of treatment at a Chronic Pain Clinic in South Africa.

METHODS

A purposive sample of 14 male patients from an outpatient Chronic Pain Clinic participated in the study in 2019. Qualitative inquiry followed a life-world dialogical interview approach. Respondent validation interviews further engaged participant perspectives. Team data analysis, thematic network diagrams and tabulations were used for analysis of the interview data. .

RESULTS

The respondents described multiple challenges of the journey to chronic pain, living with chronic pain, experiences of treatment contexts, ways of coping and the experience of living with chronic pain in relation to masculinity. Three typologies were identified: (1) aligning with hegemonic ideals, (2) a yielding masculinity or (3) an adjusted masculine identity. The findings revealed how masculine identity was positioned by the perceptions of others, interpersonally and within the individual.

CONCLUSIONS

Healthcare practitioners and public health can be responsive to the gendered context of living with difficult and long-term pain conditions. Treatment should be supportive and inclusive..

Emerging Patient-Centered Concepts in Pain Among Adults With Chronic Kidney Disease, Maintenance Dialysis, and Kidney Transplant

Patient reports of moderate to severe pain are common across the spectrum of chronic kidney disease. The synergistic effects of comorbid depression and anxiety can lead to maladaptive coping responses to pain, namely pain catastrophizing and illness-related post-traumatic stress disorder. If underlying depression and anxiety and associated maladaptive coping responses are not treated, patients can experience an increased perception of pain, worsened disability, decreased quality of life, withdrawal from social activities, and increased morbidity and mortality. Meanwhile, interest in nonpharmacologic treatments for pain that targets coping as well as comorbid anxiety and depression has been increasing, particularly given the significant societal damage that has resulted from the opioid epidemic. Evidence-based, nonpharmacologic treatments have shown promise in treating pain in areas outside of nephrology. Currently, little is known about the effects of these treatments among adults with CKD, and particularly end-stage kidney disease, when chronic pain can become debilitating. In this review, we examine patient-centered concepts related to pain that have received little attention in the nephrology literature. We also describe emerging areas of research, including omics technologies for biomarker discovery and advanced symptom clustering methods for symptom phenotyping, which may be useful to future kidney disease research and treatment.

Social Support is Inversely Associated with Sleep Disturbance, Inflammation, and Pain Severity in Chronic Low Back Pain

BACKGROUND

Chronic low back pain (CLBP) is a significant cause of disability, lost wages, and health care costs. Inflammatory mediators, such as interleukin 6 (IL-6), have been associated with LBP severity. Patients with CLBP commonly experience sleep disturbance, and poor sleep has been shown to increase pain severity and inflammation. In contrast, social support may benefit patients with chronic low back by reducing pain intensity and inflammation.

OBJECTIVES

The purpose of this study was to examine the influence of social support on the relationships among sleep disturbance, inflammation, and pain severity in patients with CLBP.

METHODS

In a cross-sectional study, men and women with CLBP were enrolled from an outpatient pain clinic. Participants completed psychometric instruments for social support, sleep quality, and pain severity. Blood samples were obtained for measurement of the pro-inflammatory cytokine, IL-6, by enzyme-linked immunoassay.

RESULTS

Linear regression revealed greater sleep disturbance predicted greater pain severity. In contrast, participants who reported higher social support had lower sleep disturbance and lower pain severity. Mediation analysis revealed sleep disturbance to mediate the relationship between social support and pain, such that sleep disturbance reduced the benefit of social support on pain severity. Further, greater sleep disturbance and lower social support predicted increased IL-6. However, IL-6 did not mediate the relationship between social support and pain.

DISCUSSION

The findings suggest that increased social support is associated with lower sleep disturbance, lower inflammation, and lower pain severity in patients with CLBP. Assessing the extent of social support and fostering social support as part of a comprehensive pain management program may benefit patients with CLBP. Interventions to strengthen social support systems and cultivate support from family and/or informal social networks may reduce symptom burden and improve quality of life.

The role of refugee and migrant migration status on medication adherence: Mediation through illness perceptions

Background

Illness perceptions may vary between different populations. This raises the question as to whether refugees and migrants of the same ethnic background have different perceptions. Understanding differences may have a significant impact on enhancing medication adherence in these groups.

Objective

The study examined the associations and differences between illness perceptions, and medication adherence in hypertensive Middle Eastern migrants and refugees.

Methods

Middle Eastern refugees and migrants (≥30 years old), with hypertension were recruited from Arabic community groups in Australia and asked to complete a cross-sectional survey. The survey consisted of basic socio-demographic and clinical profile, self-reported illness perceptions, and self-reported medication adherence. The outcome measure was the Medication Adherence Questionnaire. Simple mediation modelling was applied to examine the role of illness perceptions as a mediator between different migration statuses, and medication adherence.

Results

A total of 320 participants were recruited; 168 refugees, and 152 migrants. Educational level was found to be positively significantly associated with medication adherence in refugees, p = 0.003, while employed migrants were more likely to report higher adherence to hypertensive medication, p = 0.005. In both groups, there was a significant association between illness perceptions and medication adherence p = 0.0001. Significant differences were found between both groups regarding adherence and illness perceptions variables. Refugees had more negative illness perceptions and were less adherent than migrants. Illness perception was a mediator in the relationship between migration status and medication adherence; the unstandardized indirect effect was 0.24, and the 95% confidence interval ranged from (0.21–0.36).

Conclusions

To achieve better adherence to medications in vulnerable populations such as refugees, illness perceptions need to be understood, and differentiated from other populations, such as migrants from similar backgrounds. Patients’ education about illnesses and medications should be specific and targeted to each population. Interventional studies are recommended to modify refugees’ and migrants’ illness perceptions, to enhance medication adherence and wellbeing.