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CC BY-NC-ND 4.0 · Avicenna J Med 2021; 11(03): 145-151
DOI: 10.1055/s-0041-1734385
Original Article

Do Patients of Chronic Low Back Pain have Psychological Comorbidities?

Kritika Singhal
1   Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Krishna Prasad Muliyala
1   Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Abhijit P. Pakhare
2   Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Prateek Behera
3   Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
John Ashutosh Santoshi
3   Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Abstract

Background Individuals with chronic pain have been reported to have an increased incidence of psychological morbidities. We aimed to examine the prevalence of anxiety, depression, disability, alexithymia, insomnia, and sleep quality in patients having chronic low back pain (LBP) and study their association with the severity of pain and any disability arising from it.

Methods This descriptive study was conducted in a tertiary care teaching hospital setting. Fifty adults with nonspecific LBP of > 6-week duration were included. Study instruments employed were patient health questionnaire-9 for depression, generalized anxiety disorder-7 for anxiety, visual analogue scale (VAS) score for pain, Oswestry disability index (ODI) to assess disability, Toronto alexithymia scale-20 for alexithymia, and insomnia severity index and Pittsburgh sleep quality index for insomnia. Descriptive results were expressed as numbers, means, and proportions. Association study between variables was performed using Fisher’s exact test.

Results Mean ODI score was 31.54% (95% CI, 26.09–36.99); mean VAS score was 6.08 (95% CI, 5.35–6.81). Insomnia of varying severity was found in 29 patients. Sleep quality was reported as good by 23 patients. One patient had alexithymia. There was significant association between the level of disability and depression, anxiety, insomnia, and sleep quality. The severity of pain had significant association with insomnia but the association with anxiety, depression, alexithymia, and sleep quality was not significant.

Conclusions Patients with chronic LBP do have associated psychological comorbidities of varying extent. A “patient-centric” approach when treating patients with chronic LBP is necessary, so that appropriate evaluation of psychiatric and psychosocial comorbidities, sleep problems, and quality of life is done as part of their routine management to ensure the desired outcomes.

Keywords

low back pain - psychological - comorbidity - anxiety - depression - alexithymia - insomnia


Publication History

Article published online:
06 September 2021

© 2021. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 National Collaborating Centre for Primary Care (UK). Low Back Pain: Early Management of Persistent Non-specific Low Back Pain. London, United Kingdom: Royal College of General Practitioners 2009
  • 2 Hong JH, Kim HD, Shin HH, Huh B. Assessment of depression, anxiety, sleep disturbance, and quality of life in patients with chronic low back pain in Korea. Korean J Anesthesiol 2014; 66 (06) 444-450
    CrossrefPubMedGoogle Scholar
  • 3 Kamal KC, Alexandru DO, Kamal D. et al. Managing low back pain in primary care. Curr Health Sci J 2020; 46 (04) 396-404
    PubMedGoogle Scholar
  • 4 Sharma R. ed Epidemiology of Musculoskeletal Conditions in India New Delhi, India: Indian Council of Medical Research (ICMR) 2012
  • 5 Yu GZ, Ly M, Karim HT, Muppidi N, Aizenstein HJ, Ibinson JW. Accelerated brain aging in chronic low back pain. Brain Res 2021; 1755: 147263
    CrossrefPubMedGoogle Scholar
  • 6 Ong WY, Stohler CS, Herr DR. Role of the prefrontal cortex in pain processing. Mol Neurobiol 2019; 56 (02) 1137-1166
    CrossrefPubMedGoogle Scholar
  • 7 Yang S, Chang MC. Chronic pain: structural and functional changes in brain structures and associated negative affective states. Int J Mol Sci 2019; 20 (13) 3130
    CrossrefPubMedGoogle Scholar
  • 8 Thompson JM, Neugebauer V. Cortico-limbic pain mechanisms. Neurosci Lett 2019; 702: 15-23
    CrossrefPubMedGoogle Scholar
  • 9 Croft P, Rigby AS, Boswell R, Schollum J, Silman A. The prevalence of chronic widespread pain in the general population. J Rheumatol 1993; 20 (04) 710-713
    Google Scholar
  • 10 Liu CH, Fu TS, Lee CP, Hung CI. Reliability and validity of the Depression and Somatic Symptoms Scale among patients with chronic low back pain. Neuropsychiatr Dis Treat 2019; 15: 241-246
    CrossrefPubMedGoogle Scholar
  • 11 Jank R, Gallee A, Boeckle M, Fiegl S, Pieh C. Chronic pain and sleep disorders in primary care. Pain Res Treat 2017; 2017: 9081802
    PubMedGoogle Scholar
  • 12 Marčić M, Mihalj M, Ivica N, Pintarić I, Titlić M. How severe is depression in low back pain patients?. Acta Clin Croat 2014; 53 (03) 267-271
    PubMedGoogle Scholar
  • 13 Gebauer S, Scherrer JF, Salas J, Burge S, Schneider FD. Residency Research Network of Texas Investigators. Disability and disability benefit seeking in chronic low back pain. Occup Med (Lond 2015; 65 (04) 309-316
    CrossrefPubMedGoogle Scholar
  • 14 Serbic D, Pincus T. Pain-related guilt in low back pain. Clin J Pain 2014; 30 (12) 1062-1069
    CrossrefPubMedGoogle Scholar
  • 15 Artner J, Cakir B, Spiekermann JA. et al. Prevalence of sleep deprivation in patients with chronic neck and back pain: a retrospective evaluation of 1016 patients. J Pain Res 2013; 6: 1-6
    PubMedGoogle Scholar
  • 16 O’Donoghue GM, Fox N, Heneghan C, Hurley DA. Objective and subjective assessment of sleep in chronic low back pain patients compared with healthy age and gender matched controls: a pilot study. BMC Musculoskelet Disord 2009; 10: 122
    CrossrefPubMedGoogle Scholar
  • 17 Khatua DK, Ghosh S, Mukhopadhyay DK, Goswami N, Pan PP, Palit AK. Psychological comorbidity of chronic low back pain. Indian J Phys Med Rehabil 2011; 22: 7-11
    Google Scholar
  • 18 Pande KC. Psychological disturbance in Indian low back pain population. Indian J Orthop 2004; 38: 175
    Google Scholar
  • 19 Levis B, Benedetti A, Thombs BD. DEPRESsion Screening Data (DEPRESSD) Collaboration. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ 2019; 365: l1476
    CrossrefPubMedGoogle Scholar
  • 20 Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006; 166 (10) 1092-1097
    CrossrefPubMedGoogle Scholar
  • 21 Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain 2003; 4 (07) 407-414
    CrossrefPubMedGoogle Scholar
  • 22 Fairbank JC, Couper J, Davies JB, O’Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy 1980; 66 (08) 271-273
    PubMedGoogle Scholar
  • 23 Bressi C, Taylor G, Parker J. et al. Cross validation of the factor structure of the 20-item Toronto Alexithymia Scale: an Italian multicenter study. J Psychosom Res 1996; 41 (06) 551-559
    CrossrefPubMedGoogle Scholar
  • 24 Smith S, Trinder J. Detecting insomnia: comparison of four self-report measures of sleep in a young adult population. J Sleep Res 2001; 10 (03) 229-235
    CrossrefPubMedGoogle Scholar
  • 25 Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F. Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res 2002; 53 (03) 737-740
    CrossrefPubMedGoogle Scholar
  • 26 Soysal M, Kara B, Arda MN. Assessment of physical activity in patients with chronic low back or neck pain. Turk Neurosurg 2013; 23 (01) 75-80
    PubMedGoogle Scholar
  • 27 Adilay U, Guclu B, Goksel M, Keskil S. The correlation of SCL-90-R anxiety, depression, somatization subscale scores with chronic low back pain. Turk Neurosurg 2018; 28 (03) 434-438
    PubMedGoogle Scholar
  • 28 Jack K, McLean SM, Moffett JK, Gardiner E. Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Man Ther 2010; 15 (03) 220-228
    CrossrefPubMedGoogle Scholar
  • 29 Tagliaferri SD, Miller CT, Owen PJ. et al. Domains of chronic low back pain and assessing treatment effectiveness: a clinical perspective. Pain Pract 2020; 20 (02) 211-225
    CrossrefPubMedGoogle Scholar
  • 30 Polatin PB, Kinney RK, Gatchel RJ, Lillo E, Mayer TG. Psychiatric illness and chronic low-back pain. The mind and the spine–which goes first?. Spine 1993; 18 (01) 66-71
    CrossrefPubMedGoogle Scholar
  • 31 Kamper SJ, Apeldoorn AT, Chiarotto A. et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ 2015; 350: h444
    CrossrefPubMedGoogle Scholar
  • 32 Joshi R, Santoshi JA, Rai N, Pakhare A. Prevalence and patterns of coexistence of multiple chronic conditions: a study from Indian urban outpatient setting. J Family Med Prim Care 2015; 4 (03) 411-415
    CrossrefPubMedGoogle Scholar
  • 33 Pagé MG, Fortier M, Ware MA, Choinière M. As if one pain problem was not enough: prevalence and patterns of coexisting chronic pain conditions and their impact on treatment outcomes. J Pain Res 2018; 11: 237-254
    CrossrefPubMedGoogle Scholar
  • 34 Bener A, Verjee M, Dafeeah EE. et al. Psychological factors: anxiety, depression, and somatization symptoms in low back pain patients. J Pain Res 2013; 6: 95-101
    CrossrefPubMedGoogle Scholar
  • 35 Alsaadi SM, McAuley JH, Hush JM. et al. Detecting insomnia in patients with low back pain: accuracy of four self-report sleep measures. BMC Musculoskelet Disord 2013; 14: 196
    CrossrefPubMedGoogle Scholar
  • 36 Alsaadi SM, McAuley JH, Hush JM, Maher CG. Erratum to: Prevalence of sleep disturbance in patients with low back pain. Eur Spine J 2012; 21 (03) 554-560
    CrossrefPubMedGoogle Scholar
  • 37 Ryder AG, Sunohara M, Dere J, Chentsova-Dutton YE. The cultural shaping of alexithymia In: Taylor GJ, Luminet O, Bagby RM, eds. Alexithymia: Advances in Research, Theory, and Clinical Practice. Cambridge: Cambridge University Press 2018; 33-48
    PubMed
  • 38 Turesky DG. A Descriptive Analysis of Alexithymia among Patients with Chronic Back Pain [PhD (Doctor of Philosophy) thesis]. US: University of Iowa; 2011
  • 39 Di Tella M, Castelli L. Alexithymia in chronic pain disorders. Curr Rheumatol Rep 2016; 18 (07) 41
    CrossrefPubMedGoogle Scholar
  • 40 Rao D, Young M, Raguram R. Culture, somatization, and psychological distress: symptom presentation in South Indian patients from a public psychiatric hospital. Psychopathology 2007; 40 (05) 349-355
    CrossrefPubMedGoogle Scholar
  • 41 Morissette SB, Tull MT, Gulliver SB, Kamholz BW, Zimering RT. Anxiety, anxiety disorders, tobacco use, and nicotine: a critical review of interrelationships. Psychol Bull 2007; 133 (02) 245-272
    CrossrefPubMedGoogle Scholar