Profile of sexuality in Moroccan chronic low back pain patients

Manual therapy plus sexual advice compared with manual therapy or exercise therapy alone for lumbar radiculopathy: a randomized controlled trial

CONTEXT

The biopsychosocial approach to managing low back pain (LBP) has the potential to improve the quality of care for patients. However, LBP trials that have utilized the biopsychosocial approach to treatment have largely neglected sexual activity, which is an important social component of individuals with LBP.

OBJECTIVES

The objectives of the study are to determine the effects of manual therapy plus sexual advice (MT+SA) compared with manual therapy (MT) or exercise therapy (ET) alone in the management of individuals with lumbar disc herniation with radiculopathy (DHR) and to determine the best sexual positions for these individuals.

METHODS

This was a single-blind randomized controlled trial. Fifty-four participants diagnosed as having chronic DHR (>3 months) were randomly allocated into three groups with 18 participants each in the MT+SA, MT and ET groups. The participants in the MT+SA group received manual therapy (including Dowling's progressive inhibition of neuromuscular structures and Mulligan's spinal mobilization with leg movement) plus sexual advice, those in the MT group received manual therapy only and those in the ET group received exercise therapy only. Each group received treatment for 12 weeks and then followed up for additional 40 weeks. The primary outcomes were pain, activity limitation, sexual disability and kinesiophobia at 12 weeks post-randomization.

RESULTS

The MT+SA group improved significantly better than the MT or ET group in all outcomes (except for nerve function), and at all timelines (6, 12, 26, and 52 weeks post-randomization). These improvements were also clinically meaningful for back pain, leg pain, medication intake, and functional mobility at 6 and 12 weeks post-randomization and for sexual disability, activity limitation, pain catastrophizing, and kinesiophobia at 6, 12, 26, and 52 weeks post-randomization (p<0.05). On the other hand, many preferred sexual positions for individuals with DHR emerged, with "side-lying" being the most practiced sexual position and "standing" being the least practiced sexual position by females. While "lying supine" was the most practiced sexual position and "sitting on a chair" was the least practiced sexual position by males.

CONCLUSIONS

This study found that individuals with DHR demonstrated better improvements in all outcomes when treated with MT+SA than when treated with MT or ET alone. These improvements were also clinically meaningful for sexual disability, activity limitation, pain catastrophizing, and kinesiophobia at long-term follow-up. There is also no one-size-fits-all to sexual positioning for individuals with DHR.

The intangible costs of living with low back pain from a patient perspective: a scoping review

PURPOSE

Health-related low back pain costs can be direct monetary, indirect monetary, or intangible, non-monetary. The purpose of this review was to identify the intangible, non-monetary costs of low back pain from the perspective of the individual.

MATERIALS AND METHODS

A scoping review of literature was undertaken. Four databases were searched up to 6th August 2024. Data were charted and coded using deductively derived categories in line with our purpose; additional categories were developed for text that did not fit these categories. Data were analysed using directed content analysis.

RESULTS

Forty-six studies met the inclusion criteria. Six categories were derived from the data, which express the experience of the person with low back pain: Perceptions of pain, Experience of healthcare, Becoming defined by low back pain, Life on hold, My social self, and Disrupted work life. Each category explored an aspect of life affected by low back pain.

CONCLUSION

This review highlights that low back pain profoundly affects many areas, with implications for peoples' personal, social, and work lives. Our findings suggest that suffering can be reduced when healthcare practitioners show empathy and legitimise the lived experience of low back pain, acknowledging the restrictions it imposes on peoples' lives.

Sexual Disability in Low Back Pain: Diagnostic and Therapeutic Framework for Physical Therapists

BACKGROUND

The literature shows a relationship between sexual activity and low back pain (LBP). The aim of this work is to provide a theoretical framework and practical proposal for the management of sexual disability in individuals with LBP.

METHODS

Based on a literature review, a team of specialized physical therapists developed a pattern for the management of LBP-related sexual disability.

RESULTS

A patient reporting LBP-related sexual disability may be included in one of four clinical decision-making pathways corresponding to one of the following: #1 standard physical therapy (PT); #2 psychologically informed physical therapy (PIPT); #3 PIPT with referral; or #4 immediate referral. Standard PT concerns the management of LBP-related sexual disability in the absence of psychosocial or pathological issues. It includes strategies for pain modulation, stiffness management, motor control, stabilization, functional training, pacing activities comprising education, and stay-active advice. PIPT refers to patients with yellow flags or concerns about their relationship with partners; this treatment is oriented towards a specific psychological approach. "PIPT with referral" and "Immediate referral" pathways concern patients needing to be referred to specialists in other fields due to relationship problems or conditions requiring medical management or pelvic floor or sexual rehabilitation.

CONCLUSIONS

The proposed framework can help clinicians properly manage patients with LBP-related sexual disability.

Sex life and low back pain: The impact of intradiscal ozone therapy in patients with herniated lumbar disc

STUDY DESIGN

Retrospective cohort study.

OBJECTIVES

To assess the improvement of sexual impairment after percutaneous intradiscal ozone therapy in patients complaining of low back pain (LBP) due to lumbar disc herniation.

METHODS

Between January 2018 and June 2021, 157 consecutive imaging-guided percutaneous intradiscal ozone therapies were performed on 122 patients with LBP and/or sciatic pain due to lumbar disc herniation. Oswestry Disability Index (ODI) was administered before the treatment and at 1-month and 3-month follow-ups and the ODI Section 8 (ODI-8/sex life) values were retrospectively reviewed to evaluate the improvement of sexual impairment and disability.

RESULTS

Mean age of patients was 54.63 ± 12.40. Technical success was achieved in all cases (157/157). Clinical success was registered in 61.97% (88/142) of patients at 1-month follow-up and in 82.69% (116/142) at 3-month follow-up. The mean ODI-8/sex life was 3.73 ± 1.29 before the procedure, 1.71 ± 1.37 at 1-month follow up and 0.44 ± 0.63 at 3-month follow-up. Compared to older patients, subjects under 50 years showed a significantly slower recovery of sexual impairment (p = 0.003). The treated levels were L3-L4, L4-L5, and L5-S1 in 4, 116, and 37 patients, respectively. Patients with L3-L4 disc herniation showed less sexual disability at presentation, with a significantly faster improvement of sexual life (p = 0.03).

CONCLUSIONS

Percutaneous intradiscal ozone therapy is highly effective in reducing sexual impairment due to lumbar disc herniation, and the improvement is faster in older patients and in the case of L3-L4 disc involvement.

Sexual Difficulties in the Population with Musculoskeletal Chronic Pain: A Systematic Review

OBJECTIVE

To review the current literature on the nature and prevalence of sexual difficulties in the population with chronic musculoskeletal pain, as well as to identify the biopsychosocial factors that maintain these difficulties.

DESIGN

Systematic review.

METHODS

Studies were found by using multiple electronic databases and examining reference lists. After application of inclusion and exclusion criteria, 10 studies were eligible for review. Data were extracted and characteristics were described for outcomes of interest (i.e., sexual dysfunction, pain condition, pain intensity, psychosocial factors, gender differences). Cochrane Risk of Bias was assessed for all included studies.

RESULTS

Ten studies (2,941 participants) were included in the review. Musculoskeletal conditions included low back pain and fibromyalgia. All studies examining sexual functioning found evidence of sexual difficulty among patients with chronic pain. Three studies demonstrated that sexual dysfunction was significantly greater in patients than in healthy matched controls. Nine studies found that greater pain levels significantly correlated with greater sexual dysfunction. Eight studies noted an increased prevalence of sexual difficulties in those with comorbid psychological problems. Heterogeneity between studies was identified, particularly with regard to gender outcomes. The risk-of-bias assessment also highlighted limitations in approximately half of studies.

CONCLUSIONS

This review reiterates the importance of investigating sexual functioning in the chronic musculoskeletal pain population, given the high prevalence of chronic musculoskeletal pain across all age bands. Given methodological limitations, future research should develop measures that sensitively cater to the various needs of patients with chronic pain. By modifying assessment to include biopsychosocial concerns, practitioners can tailor treatment to address transdiagnostic factors that maintain sexual dysfunction.

Chronic primary or secondary non-inflammatory musculoskeletal pain is associated with disrupted sexual function and relationships: a systematic review

OBJECTIVE

Evidence points to the impact of chronic musculoskeletal pain conditions on sexual function, yet there is little systematic appraisal and synthesis of evidence examining these associations across non-inflammatory conditions. We aimed to systematically review evidence surrounding the association between chronic primary and secondary musculoskeletal pain with intimate relationships and sexual function.

METHODS

Four electronic databases were searched from 1^st January 1990 to 5^th September 2019 for cross-sectional or prospective epidemiologic and qualitative studies among cohorts with chronic primary or secondary non-inflammatory musculoskeletal pain, defined by ICD-11 classification criteria.

RESULTS

Fifty-one eligible studies were included (46 quantitative, 3 qualitative, 2 mixed-methods designs). Sample sizes ranged from 13 to 12,377 and mean age from 32.6 to 69.2 years. Cross-sectional controlled cohort studies consistently reported poorer sexual function outcomes among cohorts with pain relative to comparison groups. Of 15 studies reporting outcomes for the Female Sexual Function Index, 14 demonstrated mean scores ≤26.55 for the pain group, indicating sexual dysfunction. In four studies reporting the International Index of Erectile Function, the pain cohorts demonstrated consistently lower mean subscale scores and the erectile function subscale scores were ≤25.0, indicating erectile dysfunction. Three key themes emerged from a meta-synthesis of qualitative studies: impaired sexual function; compromised intimate relationships; and impacts of pain on sexual identity, body image and self-worth.

CONCLUSION

Sexual dysfunction and negative impacts on intimate relationships are highly prevalent among people with chronic non-inflammatory musculoskeletal pain. Consideration of these associations is relevant to the delivery of holistic, person-centred musculoskeletal pain care.

The effect of suffering from rheumatoid arthritis, systemic lupus erythematosus, and back pain on sexual functioning and marital satisfaction in Iran

OBJECTIVE

Sexual functioning is an important component of life quality and musculoskeletal disorders may effect sexual functioning, so, the present study was conducted to evaluate sexual functioning in patients suffering from back pain, rheumatoid arthritis, and systemic lupus erythematosus (SLE).

METHODS

This study was conducted on 102 patients with rheumatoid arthritis, 103 patients with back pain, 103 patients with SLE, and 210 people in the control group by the consecutive sampling method. The marital satisfaction questionnaire (Enrich), Arizona Sexual Experience Scale (ASEX) questionnaire, and the General Health Questionnaire (GHQ-28) were completed by all the subjects. Disease severity was determined in each group of patients by Disease Activity Score of 28 joints, the Roland Morris questionnaire, and the SLE Disease Activity Index questionnaire.

RESULTS

The GHQ in rheumatoid arthritis and lupus patients was meaningfully higher than the control group (P < .05), while there was no meaningful difference between back pain patients and the control group (P = .414). The sexual functioning questionnaire score in all 3 groups showed no statistically meaningful difference with the control group (P < .05). Also, the marital satisfaction questionnaire score in all the groups showed no statistically meaningful difference compared to the control group (P = .791).

CONCLUSION

The study has shown that the level of sexual function in participants with back pain and the level of mental health and sexual functioning in patients with rheumatoid arthritis and SLE are significantly lower than healthy people and there is a need for intervention for improving mental health as well as sexual functioning in these patients.

CORRELATION BETWEEN CHRONIC LOW BACK PAIN AND FEMALE SEXUAL FUNCTION

ABSTRACT Objective To correlate chronic low back pain with female sexual function. Methods This is a cross-sectional study. Thirty-two women aged between 18 and 44 years old, with body mass index (BMI) between 18.5 kg/m2 and 29.9 kg/m2, with a medical diagnosis of chronic low back pain and sexually active in the last six months were selected. The patients underwent a physical therapy evaluation and responded to two questionnaires: the Roland-Morris Disability Questionnaire and the Female Sexual Quotient (QS-F). Pearson’s correlation test was used to assess the impact of chronic low back pain on sexual activity. Results The mean age was 30.31 years old (±.7.10) and the mean BMI was 24.54 Kg/m2 (±3.06). The mean Roland-Morris Disability Questionnaire score was 5.2 ( ± 3.28), indicating that the patients did not have significant disability. The mean QS-F score was 60.37 (±14.48), classified as “unfavorable to normal”. The correlation test showed a low correlation between chronic low back pain and female sexual function (r = 0.027). Conclusion There was a low correlation between chronic low back pain and female sexual function in the study population, but the moderate correlation between the “comfort” domain and the Roland-Morris Disability Questionnaire score was significant. Level of evidence II ; Cross-sectional clinical study.

Low back pain and sexual disability from the patient's perspective: a qualitative study

PURPOSE

The aim of this qualitative study is to investigate, from patient's perspective, the aspects of the relationship between low back pain and sexual life on physical, psychological and social aspects of individual's life. In addition, this study aims to explore patients' opinions on the role of health care providers in addressing and treating low back pain-related sexual problems.

MATERIALS AND METHODS

Semi-structured interviews were conducted with 26 outpatients referred to physical therapy for subacute or chronic non-specific low back pain; the questions investigated the presence of sexual disability and aspects related to patient's behaviour. Two independent physical therapists, supervised by a third expert physical therapist and a clinical psychologist proficient in qualitative methodology, performed thematic content analysis to identify categories and themes.

RESULTS

Patients with low back pain consider sexual disability severely limiting and correlated to pain. This study emphasized the perception of invalidity, the importance of the relationship with the partner, the emotions and gender roles in the couple, and the relevance for health care providers to take part in the clinical management. The physical therapist is believed to be a qualified figure to address this issue and specific suggestions on sexual activity could be useful.

CONCLUSION

Sexual disability in patients with subacute or chronic LBP acquires an important and individual meaning that can be investigated within the therapeutic context, especially by physical therapists.Implications for RehabilitationSexual disability related to low back pain is considered an important and meaningful topic from the patient's perspective.This reflects the importance of the emotional relationship with the partner.Within the therapeutic context, it is important to provide information to help manage pain during sexual activity.The physical therapist is seen to be a qualified figure to address this issue.

Cross-cultural adaptation and psychometric testing of the Arabic version of the Modified Oswestry Low Back Pain Disability Questionnaire

Background

The Modified Low Back Pain Disability Questionnaire (MLBPDQ) is used for evaluating the functional disability in patients with low back pain (LBP). However, the measurement characteristics of the MLBPDQ among Arab patients are unknown. In this study, we aimed to translate and cross-culturally adapt the MLBPDQ into Arabic and evaluate its psychometric properties.

Methods

An Arabic version of the MLBPDQ was developed through forward translation, translation synthesis, and backward translation. Sixty-eight patients (55 males and 13 females) with a mean age 37.01 ± 7.57 years were recruited to assess its psychometric properties. Reliability was evaluated using internal consistency (Cronbach’s α), test retest reliability (utilizing intraclass correlation coefficient [ICC]), standard error of measurement (SEM), minimal detectable change at 95% confidence level (MDC_95%), and 95% limits of agreement (LOA). The construct validity was investigated by correlating the new translation with four other measures of LBP (using Spearman’s rho). Finally, receiver operating characteristic curve was constructed to compute the sensitivity, using the area under the curve (AUC), and the minimum important change (MIC). An alpha level of 0.05 was set for statistical tests and all the psychometric values were tested against a priori hypotheses.

Results

The culturally aligned MLBPDQ showed good internal consistency (Cronbach’s α = 0.85). The ICC, SEM, MDC_95%, and LOA between baseline and two days later were 0.98, 1.60, 4.43, and -4.23 to 7.70, respectively, while the values between baseline and 14 days later were 0.94, 2.77, 7.67, and -6.59 to 13.53, respectively. The scale also demonstrated moderate to excellent correlation (rho = 0.54–0.86) with the other four questionnaires. The AUC value of the Arabic-MLBPDQ was 0.68, and the MIC was 3 points.

Conclusion

The Arabic version of the MLBPDQ demonstrates adequate psychometric properties and can be used to assess disability level in patients with LBP in Arabic-speaking communities.

Association between low back pain and various everyday performances : Activities of daily living, ability to work and sexual function

Low back pain (LBP) is a widely prevalent chronic pain disorder associated with a high burden on individuals and society. In the subjective perception of patients with LBP, probably the most important health outcomes associated with LBP are those that effect everyday performance. Such outcomes include reduction in activities of daily living (ADL), in work ability (WA), and in sexual function. This narrative review aimed to (1) examine the association between LBP and the three mentioned outcomes of everyday performance, (2) to explain possible mediating factors promoting these associations, and (3) to discuss possible implications for treatment and rehabilitation. Studies have shown that LBP can generate anxiety of movement leading to movement avoidance (fear-avoidance beliefs), which may lead to deconditioning and further increasing problems with ADL, WA and decreasing sexual function. Furthermore, common mental disorders, such as depression, anxiety, and stress-related disorders, which also often co-occur with LBP can lead to adverse effects on everyday performance and vice versa, can be the consequence of such problems and aggravate LBP. Although there is no universally accepted treatment modality that fits every patient with LBP, physical training, comprehensive patient education, and workplace or home modifications have been shown to be able to interrupt the mutual influence between LBP and the described mediating factors, and have a beneficial effect on ADL, WA, and sexual function. For this, a multidisciplinary approach is necessary which includes multiprofessional care teams, participation of the patients, and involvement of different settings, such as workplace, home, and physical training facilities.

Sexual disability in patients with chronic non-specific low back pain-a multicenter retrospective analysis

[Purpose] Oswestry Disability Index includes an item (Oswestry Disability Index-8) aiming to assess sexual disability associated to low back pain. The aim of this study is to investigate the percentage of participants who answered the Oswestry Disability Index-8, and the relevance and characteristics of sexual disability due to low back pain in Italian patients. [Participants and Methods] Design: multicenter retrospective analysis. Population: six hundred and ninety-seven outpatients with non-specific low back pain. Variables: pain characteristics (amount, localization, and duration of perceived pain), disability, and psychological variables (anxiety, depression, catastrophizing, kinesiophobia, pain acceptance, and pain vigilance and awareness). [Results] Seventy-seven participants (11.05%) did not answer the Oswestry Disability Index-8. The odds of being not responding to the Oswestry Disability Index-8 item appeared related to age (odds=7.50 for over 60), gender (odds=2.65 for females), and marital status (odds=2.33 for not married). Concerning the psychological variables, Activity Avoidance (coefficient=0.071), Depression (coefficient=0.068), and Rumination (coefficient=0.031) showed a positive impact on sexual disability. [Conclusion] In Italian patients, the percentage of not-responding to Oswestry Disability Index-8 was relatively low. In addition, sexual disability was related to depression, activity avoidance, and rumination.

Sexual life satisfaction of methadone-maintained Chinese patients: individuals with pain are dissatisfied with their sex lives

Purpose

Pain is potentially associated with sexual dysfunction. Both sexual dysfunction and pain are common in methadone-maintained patients, but the association of pain with sexual dysfunction in methadone-maintained patients is rarely studied. This study examined the association between pain and sexual life satisfaction (SLS) in Chinese patients receiving methadone maintenance treatment (MMT).

Patients and methods

A total of 477 methadone-maintained patients who recently had sex with their sex partners were recruited from three MMT clinics in Wuhan, China. SLS was assessed with a single question, and the sociodemographic, psychological, and clinical data were collected with standardized questionnaires. Pain intensity was assessed with the 5-point verbal rating scale. Multiple ordinary logistic regression was used to control for potential confounders that may bias the pain–SLS relationship.

Results

The prevalence of self-reported dissatisfaction with one’s sexual life was significantly higher in patients with clinically significant pain (CSP) than those without CSP (41.5% vs 19.4%, χ² =23.567, P<0.001). After controlling for potential sociodemographic, psychological, and clinical confounders, CSP was still significantly and independently associated with an increase in sexual life dissatisfaction (OR =1.89, P=0.011).

Conclusion

Pain is significantly associated with low SLS in methadone-maintained patients. Appropriate pain management might improve SLS of patients receiving MMT.

Sexual Quality of Life, Sexual Knowledge, and Attitudes of Older Adults on the Example of Inhabitants Over 60s of Bialystok, Poland

Introduction: Aging has a strong influence on the quality of relationships and sexual functioning, but in itself does not cause a lack of sexual desire.

Objectives: The aim of this study was to assess the quality of sexual life and define sexual knowledge and attitudes of older people on the example of residents of Bialystok, Poland at the age of 60 and over.

Methods: The study included 170 people, inhabitants of Bialystok, Poland aged over 60: 85 students of the University of Healthy Senior and the University of Psychogeriatric Prophylaxis and 85 students of the University of the Third Age. The study used three standardized psychometric scales: Sexual Quality of Life Questionnaire-Male (SQoL-M), Sexual Quality of Life Questionnaire-Female (SQoL-F), and Aging Sexual Knowledge and Attitudes Scale (ASKAS).

Results: The overall mean score for the ASKAS scale for knowledge was 65.21 ± 12.32 and for attitudes −124.65 ± 22.00. The overall mean SQOL score was 62.92 ± 18.18. Taking into account the gender of the respondents, the knowledge of men on sexuality of seniors was at the level of 63.48 ± 12.63, while in the female group −65.74 ± 12.23. The attitudes of men on sexuality of seniors was at the level of 128.80 ± 21.56, while in the female group −123.38 ± 22.05. Satisfaction with sex life among men (72.36 ± 27.49) was significantly higher than among women (60.02 ± 12.88).

Discussion: The seniors were characterized by moderate knowledge and attitudes to sexuality of older people and the average level of sexual satisfaction. There was no significant relationship between knowledge on sexuality and sexual satisfaction in the study groups, and there was a positive correlation between attitudes toward sexuality and the satisfaction of sex life outside the group of men. In addition, a significant positive relationship was found between attitudes toward sexuality and sexual satisfaction. In order to improve the knowledge of senior citizens about sexuality of old age and to overcome the taboos that are prevalent in this topic, a structured training should be provided in this field. Such training should be carried out by specialists in the field of sexology. It is desirable to conduct in-depth studies in the assessment of knowledge, attitudes, and quality of sexual life in a larger research group, in order to get results for the population of the whole country.

Assessment of physicians' addressing sexuality in elderly patients with chronic pain

Objective

To determine the frequency with which physicians address their older adult patients with chronic pain about the issue of sexuality.

Methods

It is a cross sectional, descriptive, analytical study in which physicians answered a questionnaire comprising questions related to addressing the issue of sexuality during appointments.

Results

A sample of 155 physicians was obtained, 63.9% stated they did not address sexuality in medical interviews and 23.2% did it most of the time. The main reasons for not addressing were lack of time, fear of embarrassing the patient and technical inability to address the issue.

Conclusion

There is a need to develop strategies to increase and improve addressing of sexuality in elderly patients with chronic pain, in order to have better quality of life.

Effect of Fixed Versus Adjusted Transcutaneous Electrical Nerve Stimulation Amplitude on Chronic Mechanical Low Back Pain

OBJECTIVES

This study aimed to investigate the effect of adjusting pulse amplitude of transcutaneous electrical nerve stimulation versus fixed pulse amplitude in treatment of chronic mechanical low back pain.

DESIGN

Randomized clinical trial.

SETTING

El-sahel Teaching Hospital, Egypt.

PARTICIPANTS

Forty-five patients with chronic low back pain assigned to three equal groups. Their ages ranged from 20 to 50 years.

INTERVENTION

The three groups received the same exercise program. Group A received transcutaneous electrical nerve stimulation with fixed pulse amplitude for 40 minutes. Group B received transcutaneous electrical nerve stimulation with adjusted pulse amplitude for 40 minutes, with the pulse amplitude adjusted every 5 minutes. Group C received exercises only. Treatment sessions were applied three times per week for 4 weeks for the three groups.

OUTCOME MEASURES

A visual analogue scale was used to assess pain severity, the Oswestry Disability Index was used to assess functional level, and a dual inclinometer was used to measure lumbar range of motion. Evaluations were performed before and after treatment.

RESULTS

Visual analogue scale, Oswestry Disability Index, and back range of motion significantly differed between the two groups that received transcutaneous electrical nerve stimulation and the control group and did not significantly differ between fixed and adjusted pulse amplitude of transcutaneous electrical nerve stimulation.

CONCLUSION

Adjusting pulse amplitude of transcutaneous electrical nerve stimulation does not produce a difference in the effect of transcutaneous electrical nerve stimulation used to treat chronic low back pain.

Association of pain and depression in those with chronic low back pain: the mediation effect of patient sexual functioning

OBJECTIVES

One theoretical model suggests that the pathway from pain to depression is through the disruption of social and relationship function. This study sought to test this hypothesis by considering the mediating effect of sexual functioning on the association between pain intensity and depressive symptoms in sexually active patients with chronic low back pain.

MATERIALS AND METHODS

This was a cross-sectional study on consecutive patients attending a chronic pain management clinic in Iran. All measures (pain intensity, depressive symptoms, sex-specific sexual function) were obtained by a self-report questionnaire, completed by patients while attending the clinic. Sobel testing, including bias-corrected bootstrapping, was used to produce 95% confidence intervals (95% CI) to test the mediating effect of sexual function.

RESULTS

A total of 742 patients (351 men, 391 women) took part in this study. Both the male and female mediation models showed a significant association between pain intensity and depressive symptoms, and both the models were significantly mediated by sexual functioning (P<0.001). Effect size calculations show a medium to large effect on male patients (κ 0.23; 95% CI, 0.15-0.39) and a medium effect for female patients (κ 0.16; 95% CI, 0.06-0.28). Both the models accounted for over 50% of the variance in depressive symptoms (model R).

DISCUSSION

This study has shown that sexual functioning significantly mediates the relationship between pain intensity and depressive symptoms in sexually active patients with chronic low back pain. Clinicians may wish to consider the assessment of sexual functioning within this patient group and align treatments that address sexual dysfunction and general pain management.