Impact of Psychosocial Factors in Patients with Chronic Low Back Pain
SEPTEMBER 12, 2013
Amber N. Mitchell, MD
In “Are Psychosocial Factors Associated With Low Back Pain and Work Absence for Low Back Pain in an Occupational Cohort?,” their study exploring the impact of psychosocial factors on low back pain and absence from work, published in The Clinical Journal of Pain, Urquhart et al used univariate and multivariate analyses with binary logistic regression of the data obtained from validated questionnaires to show that somatization and low job security are independently associated with low back pain (LBP) prevalence.
Analysis also revealed that negative beliefs, pain catastrophizing (irrational thoughts of negativity), reduced job satisfaction, and a high degree of occupational support were independently associated with duration of leave time from work from LBP.1
The study population pool in this retrospective analysis was derived from nurses from three medical centers in Victoria, Australia (n = 3,086) of which 1,111 signed informed consent and were eligible to participate in the study (response rate was 38.6%). The study population was interviewed via self-administered questionnaires that assessed demographics, occupational activities, musculoskeletal symptoms, physical functioning, and psychosocial functioning. The prevalence of LBP was assessed using the Nordic Questionnaire, which asked if lower back pain lasting longer than one day resulted in absence from work in the past 12 months. The Back Beliefs Questionnaire was used to assess conceptions of back pain, including negative beliefs, pain catastrophizing, resilience, and somatization. The Pain Catastrophizing Scale was used to quantify the feature of catastrophizing, which involves negatively perceiving current pain, or anticipating negative outcomes from future pain experiences.
The somatization subscale of the Brief Symptoms Inventory was used to assess for somatization, the manifestation of psychological stress in somatic form. The Connor-Davidson Resilience Scale was used to assess resilience, the ability to overcome misfortune or change. The Karasek model of job control and demand was used to examine occupational psychosocial factors. Job strain was determined by the composite variables for job control and job demand. Other endpoints that were assessed by ordinal ranking on questionnaires included job satisfaction, job security, and job support. The analytic sample was examined using univariate and multivariate analyses to test the individual effects of each psychosocial factor (unique to the patient or to the work environment) on prevalence of low back pain and occupational leave rates. Binary logistic regression with the SPSS Statistics 17.0 program was used.
The data gleaned from the 38% of qualified responders (1,111 of 3,086) was used for analysis. Slightly more than 50% (55.7%) self-reported presence of LBP in the past 12 months. Analysis of the characteristics of responders showed that they were nearly matched for most items, including female gender, body mass index, mean age in fourth decade, and hourly work duration. After adjustment for age, gender, and BMI in multivariate analyses, low job security and presence of somatization were independently associated with LBP based on odds ratios with 95% confidence intervals with P-value < 0.05 for statistical significance.
An occupational attrition rate of 29.7% was reported amongst those with LBP over the past 12-month period. Pain catastrophizing and negative beliefs about back pain were independently associated with occupational attrition after controlling for confounding variables in the regression analysis. Finally, the regression model showed that low job satisfaction and high job support were associated with leave from work due to LBP.