Relationship between misbeliefs and psychosocial factors with pain and functionality in patients with low back pain

Abstract

Introduction: Low back pain is the main cause of years lived with disability in the world, which makes it necessary to have a better understanding of the factors related to low back pain. Psychosocial factors have been considered as factors of development, aggravation and chronification of low back pain. On the other hand, recent studies have evidenced the influence of misbeliefs in patients with low back pain. Despite this, there is a lack of knowledge about the relation between misbeliefs and psychosocial factors with the pain and functionality of patients with low back pain, especially in patients with different classifications of low back pain. Objective: To assess the relation between psychosocial factors and misbeliefs with the pain intensity and functionality of patients with low back pain, and to compare sociodemographic and clinical characteristics, lifestyle, psychosocial factors, and misbeliefs among different types of low back pain (localized low back pain, irradiated low back pain, and widespread chronic pain). Methods: An analytical cross-sectional study was conducted in 472 patients with non-specific low back pain recruited in physiotherapy
outpatients and invited by community announcements. The patients fulfilled a self-reported questionnaire including sociodemographic and clinical questions, characteristics of pain, functionality, psychosocial factors, and misbeliefs (negative and positive beliefs). The participants were classified into three subgroups (localized low back pain, irradiated low back pain, and widespread chronic pain). Two multivariate models were performed with the variables of pain and functionality (dependent variables) and the psychosocial factors and misbeliefs (independent variables), beyond comparison of the subgroups characteristics.
Results: The domains of kinesiophobia [Exp B (CI 95%)] [pain: 4.92 (2.24, 10.78); functionality: 2.59 (1.13, 5.92)], catastrophization [pain: 2.23 (1.38, 3.59); functionality: 2.64 (1.77, 3.95)], and misbelief regarding the need for rest [pain: 2.23 (1.17, 4.25); functionality:
1.69 (1.06, 2.70)] were associated with higher levels of pain intensity and functional limitation. Participants with misbeliefs about return to work [pain: 1.65 (1.01, 2.71)] were more likely to report severe pain. In addition, participants with social isolation [functionality: 1.94 (1.28, 2.94)] and forced change of housing [functionality: 1.82 (1.03, 3.22)] were more likely to present high levels of functional limitation. In the comparison of low back pain subgroups, patients with widespread chronic pain have sociodemographic and clinical differences compared to the other subgroups, for instance, a greater number of comorbidities (widespread chronic pain: 2.34±1.90; localized low back pain: 1.08±1.24; irradiated low back pain: 1.51±1.39; p=0.001). Patients with localized low back pain presented lower intensity of pain (localized low back pain: 4.18±2.19; irradiated low back pain: 5.40±2.55; widespread chronic pain: 5.34±2.56; p<0.001), besides the impairment of functionality and interference of pain in daily activities when compared to the other groups. Patients with widespread chronic pain and irradiated low back pain had greater prevalence of psychosocial factors and misbeliefs than the localized pain group, with a predominance of some domains in the group of widespread chronic pain. Conclusion: Kinesiophobia, catastrophization, social isolation, forced change of housing, misbelief in relation to the need for rest and return to work represent risk factors for greater pain intensity and greater impairment of functionality in patients with nonspecific low back pain. In addition, patients with different types of low back pain had different phenotypes.