Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20210062
Brazilian Journal of Pain
Original Article

Characterization of biopsychosocial factors of patients with chronic nonspecific low back pain

Caracterização de fatores biopsicossociais de pacientes com dor lombar crônica inespecífica

Jessica Roberta de Oliveira Rocha; Manuela Karloh; Adair Roberto Soares dos Santos; Tatiane Regina de Sousa

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Abstract

BACKGROUND AND OBJECTIVES: Low back pain is considered a public health problem worldwide and has a personal, social, occupational and economic impact. Psychosocial signs such as inappropriate beliefs about pain, fear of movement, anxiety, stress, depression and low job satisfaction are characteristics of individuals with low back pain. These clinical signs are mediators of chronic pain and disability. The present study aimed to assess psychological comorbidities in patients with chronic non-specific low back pain who are undergoing physical therapy and patients awaiting physical therapy; in addition to characterizing the psychosocial profile of these individuals.

METHODS: This research was carried out with 31 individuals recruited from physical therapy clinics in the region of greater Florianópolis. They were divided into two groups: Treatment (TG) and non-treatment (CG). The following self-report instruments were applied: Hospital Anxiety and Depression Scale (HADS), Health Status Questionnaire (SF-36V2), Visual Analog Scale (VAS), Oswestry Low Back Pain Disability Index (OLBPDI), Fear-Avoidance Belief Questionnaire (FABQ) and Pain Castatrophizing Scale (PCS).

RESULTS: Significant differences (p<0.05) were observed in the scores of the instruments applied between the groups. The CG had higher averages than the GT.

CONCLUSION: The results obtained in this study support previous findings about the benefits of physical therapy for individuals with chronic nonspecific low back pain, suggesting that, in addition to reducing pain and disability, there are benefits related to psychosocial factors.

Keywords

Anxiety, Catastrophization, Physical therapy modalities, Low back pain, Quality of life

Resumo

JUSTIFICATIVA E OBJETIVOS: A dor lombar é considerada um problema de saúde pública em todo o mundo e gera impacto pessoal, social, ocupacional e econômico. Os sinais psicossociais como crenças inapropriadas sobre a dor, medo do movimento, ansiedade, estresse, depressão e baixa satisfação no trabalho são características de indivíduos com lombalgia. Esses sinais clínicos são mediadores da dor crônica e incapacidade. O presente estudo teve como objetivo avaliar as comorbidades psicológicas em pacientes com dor lombar crônica inespecífica que estão em atendimento fisioterapêutico e pacientes que aguardam o atendimento de fisioterapia; além de caracterizar o perfil psicossocial desses indivíduos.

MÉTODOS: Estudo realizado com 31 indivíduos, recrutados em clínicas de fisioterapia na região da grande Florianópolis. Foram divididos em dois grupos: tratamento (GT/n=16) e não tratamento (GC/n=15). Foram aplicados os seguintes instrumentos de autorrelato: Hospital Anxiety and Depression Scale (HADS), Health Status Questionnaire (SF-36V2), Escala Analógica Visual (EAV), Oswestry Low Back Pain Disability Index (OLBPDI), Fear-Avoidance Belief Questionnaire (FABQ) and Pain Castatrophizing Scale (PCS).

RESULTADOS: Foram observadas diferenças significativas (p<0,05) nos escores dos instrumentos aplicados entre os grupos. Sendo que o GC apresentou médias maiores que o GT.

CONCLUSÃO: Os resultados obtidos neste estudo apoiam descobertas anteriores sobre os benefícios da fisioterapia para indivíduos com dor lombar crônica inespecífica, sugerindo que, além da redução da dor e incapacidade, há benefícios relacionados aos fatores psicossociais.

Palavras-chave

Ansiedade, Catastrofização, Dor lombar, Fisioterapia, Qualidade de vida

References

Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017;1:CD011279.

Meziat Filho N, Silva GA. Invalidez por dor nas costas entre segurados da previdência social do Brasil. Rev Saúde Pública. 2011;45(3):494-502.

Grabovac I, Dorner TE. Association between low back pain and various everyday performances: activities of daily living, ability to work and sexual function. Wien Klin Wochenschr. 2019;131(21-22):541-9.

Azevedo DC, Van Dillen LR, Santos Hde O, Oliveira DR, Ferreira PH, Costa LO. Movement system impairment-based classification versus general exercise for chronic low back pain: protocol of a randomized controlled trial. Phys Ther. 2015;95(9):1287-94.

an Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A. COST B13 Working Group on Guidelines for the management of acute low back pain in primary care. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15(Suppl 2):S169-91.

Meleger AL, Krivickas LS. Neck and back pain: musculoskeletal disorders. Neurol Clin. 2007;25(2):419-38.

Linton SJ, Shaw WS. Impact of psychological factors in the experience of pain. Phys Ther. 2011;91(5):700-11.

Nicholas MK, Linton SJ, Watson PJ, Main CJ. Early identification and management of psychological risk factors (“yellow flags”) in patients with low back pain: a reappraisal. Phys Ther. 2011;91(5):737-53.

Overmeer T, Linton SJ, Boersma K. Do physical therapists recognise established risk factors? Swedish physical therapists’ evaluation in comparison to guidelines. Physiotherapy. 2004;90(1):35-41.

Lee HS, Kim DJ, Oh Y, Min K, Ryu JS. The effect of individualized gradable stabilization exercises in patients with chronic low back pain: case-control study. J Back Musculoskelet Rehabil. 2016;29(3):603-10.

Chou R, Qaseem A, Snow V, Casey D, JT Jr Cross, Shekelle P. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-91.

McGill SM. Low back stability: from formal description to issues for performance and rehabilitation. Exerc Sport Sci Rev. 2001;29(1):26-31.

Delitto A, George SZ, Van Dillen L, Whitman JM, Sowa G, Shekelle P. Low back pain. J Orthop Sports Phys Ther. 2012;42(4):A1-57.

Overmeer T, Linton SJ, Holmquist L, Eriksson M, Engfeldt P. Do evidence-based guidelines have an impact in primary care? A cross-sectional study of Swedish physicians and physiotherapists. Spine. 2005;30(1):146-51.

Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-70.

Malta M, Cardoso LO, Bastos FI, Magnanini MM, Silva CM. STROBE: initiative: guidelines on reporting observational studies. Rev Saude Publica. 2010;44(3):559-65.

Miot HA. Tamanho da amostra em estudos clínicos e experimentais. J Vasc Bras. 2011;10(4):275-8.

Falavigna A, Teles AR, Braga GL, Barazzetti DO, Lazzaretti L, Trecnago AC. Instrumentos de avaliação clínica e funcional em cirurgia da coluna vertebral. Coluna. 2011;10(1):62-7.

Summers S. Evidence-based practice part 2: reliability and validity of selected acute pain instruments. J Perianesth Nurs. 2001;16(1):35-40.

Vigatto R, Alexandre NM, Correa Filho HR. Development of a Brazilian Portuguese version of the Oswestry Disability Index: cross-cultural adaptation, reliability, and validity. Spine. 2007;32(4):481-6.

Abreu AM, Faria CD, Cardoso SM, Teixeira-Salmela LF. Versão brasileira do Fear Avoidance Beliefs Questionnaire. Cad Saude Publica. 2008;24(3):615-23.

Sehn F, Chachamovich E, Vidor LP, Dall-Agnol L, de Souza IC, Torres IL. Cross-cultural adaptation and validation of the Brazilian Portuguese version of the pain catastrophizing scale. Pain Med. 2012;13(11):1425-35.

Sullivan MJL, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychological Assessment. 1995;7(4):524-32.

Sardá Junior J, Nicholas MK, Pereira IA, Pimenta CAM, Asghari AC, Cruz RM. Validação da Escala de Pensamentos Catastróficos sobre dor. Acta Fisiatr. 2008;15(1):31-6.

Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028-37.

Qaseem A, Wilt TJ, McLean RM, Forciea MA. Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back. 2017;166(7):514-30.

Byström MG, Rasmussen-Barr E, Grooten WJ. Motor control exercises reduces pain and disability in chronic and recurrent low back pain: a meta-analysis. Spine. 2013;38(6):E350-8.

Cecchi F, Pasquini G, Paperini A, Boni R, Castagnoli C, Pistritto S. Predictors of response to exercise therapy for chronic low back pain: result of a prospective study with one-year follow-up. Eur J Phys Rehabil Med. 2014;50(2):143-51.

Wertli MM, Rasmussen-Barr E, Weiser S, Bachmann LM, Brunner F. The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review. Spine J. 2014;14(5):816-36.e4.

Stagg NJ, Mata HP, Ibrahim MM, Henriksen EJ, Porreca F, Vanderah TW. Regular exercise reverses sensory hypersensitivity in a rat neuropathic pain model: role of endogenous opioids. Anesthesiology. 2011;114(4):940-8.

Tagliaferri SD, Miller CT, Owen PJ, Mitchell UH, Brisby H, Fitzgibbon B. Domains of chronic low back pain and assessing treatment effectiveness: a clinical perspective. Pain Pract. 2020;20(2):211-25.

Ulger O, Demirel A, Oz M, Tamer S. The effect of manual therapy and exercise in patients with chronic low back pain: double blind randomized controlled trial. J Back Musculoskelet Rehabil. 2017;30(6):1303-9.

Karos K, Meulders A, Gatzounis R, Seelen HAM, Geers RPG, Vlaeyen JWS. Fear of pain changes movement: Motor behaviour following the acquisition of pain related fear. Eur J Pain. 2017;21(8):1432-42.

Brox JI, Storheim K, Holm I, Friis A, Reikerås O. Disability, pain, psychological factors and physical performance in healthy controls, patients with sub-acute and chronic low back pain: a case-control study. J Rehabil Med. 2005;37(2):95-9.

Finan PH, Smith MT. The comorbidity of insomnia, chronic pain, and depression: dopamine as a putative mechanism. Sleep Med Rev. 2013;17(3):173-83.

de Heer EW, Gerrits MM, Beekman AT, Dekker J, van Marwijk HW, de Waal MW. The association of depression and anxiety with pain: a study from NESDA. PLoS One. 2014;9(10):e106907.

Díaz-Cerrillo JL, Rondón-Ramos A, Clavero-Cano S, Pérez-González R, Martinez-Calderon J, Luque-Suarez A. Factores clínico-demográficos asociados al miedo-evitación en sujetos con lumbalgia crónica inespecífica en atención primaria: análisis secundario de estudio de intervención. Aten Primaria. 2019;51(1):3-10.

Díaz-Cerrillo JL, Rondón-Ramos A, Pérez-González R, Clavero-Cano S. Ensayo no aleatorizado de una intervención educativa basada en principios cognitivo-conductuales para pacientes con lumbalgia crónica inespecífica atendidos en fisioterapia de atención primaria. Aten Primaria. 2016;48(7):440-8.

Smeets RJ, Vlaeyen JW, Kester AD, Knottnerus JA. Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. J Pain. 2006;7(4):261-71.

Marshall PW, Kennedy S, Brooks C, Lonsdale C. Pilates exercise or stationary cycling for chronic nonspecific low back pain: does it matter? A randomized controlled trial with 6-month follow-up. Spine (Phila Pa 1976). 2013;38(15):E952-9.

Hajihasani A, Rouhani M, Salavati M, Hedayati R, Kahlaee AH. The influence of cognitive behavioral therapy on pain, quality of life, and depression in patients receiving physical therapy for chronic low back pain: a systematic review. PM R. 2019;11(2):167-76.

Main CJ, George SZ. Psychosocial influences on low back pain: why should you care?. Phys Ther. 2011;91(5):609-13.


Submitted date:
03/02/2021

Accepted date:
06/24/2021

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