DETERMINATION OF EMOTIONAL AND BEHAVIORAL FACTORS ASSOCIATED WITH PAIN SEVERITY IN PATIENTS WITH CHRONIC LOW BACK PAIN

Year 2024, , 168 - 174, 29.04.2024

Mehmet Duray , Merve Karapınar

https://doi.org/10.18229/kocatepetip.1276093

Abstract

OBJECTIVE: The primary aim of the study was to determine which emotional and behavioral factors affect the pain severity and to what extent in patients with chronic low back pain (LBP).
MATERIAL AND METHODS: One hundred and seventy-eight patients with LBP participated in the cross-sectional study. The primary outcome was the Visual Analog Scale (VAS) evaluated the pain severity during rest (VASrest) and activity (VASact). Secondary outcomes included the Pain Beliefs Questionnaire (PBQ), The Pain Coping Questionnaire (PCQ) and The Fear-Avoidance Beliefs Questionnaire (FABQ).
RESULTS: While PBQ scores increased, VASrest and VASact scores decreased significantly (p< 0.05). There was a positive and significant correlation between VASrest and only Medical Remedies Subparameter of PCQ(p=0.008), and between VASactivity and only Helpless Subparameter of PCQ (p<0.05). VASrest and VASact had positive and significant associations with FABQ scores (p< 0.05). The results of the regression analysis showed that pain-related psychologic beliefs are the main determinants of VASrest(p=0.014) and VASact (p=0.006). Pain related organic beliefs had a significant but lower effect on VASrest (p=0.019) and VASact (p=0.031). It was observed that seeking a medical remedy for pain at rest had a significant effect on reducing the VAS scores(p=0.024).
CONCLUSIONS: Inadequacies in the management of negative beliefs associated with pain contribute to the exacerbation of pain even at rest. However, neither fear avoidance behavior nor coping strategies except medical remedies developed for pain at rest do not reduce pain severity.

Keywords

Low back pain, Beliefs, Coping strategies, Fear avoidance, Psychosocial factors

KRONİK BEL AĞRILI HASTALARDA AĞRI ŞİDDETİ İLE İLİŞKİLİ EMOSYONEL VE DAVRANIŞSAL FAKTÖRLERİN BELİRLENMESİ

Abstract

AMAÇ: Çalışmamızın amacı, kronik bel ağrısı olan hastaların emosyonel ve davranışsal faktörlerin hastaların ağrı şiddetini ne ölçüde etkilediğini belirlemektir.
GEREÇ VE YÖNTEM: Kesitsel tipteki araştırmamıza kronik bel ağrısı olan yüz yetmiş-sekiz hasta dahil edildi. Birincil değerlendirme parametrelerimiz dinlenme ve aktivite sırasındaki ağrı şiddetini değerlendiren Görsel Analgol Sklası (GASdinlenme, GASaktivite) idi. İkincil değerlendirme parametrelerimiz ise Ağrı İnançları Anketi (AİA), Ağrıyla Başa Çıkma Ölçeği (ABÇÖ) ve Korku-Kaçınma İnançları Anketidir (KKİA).
BULGULAR: Hastaların Ağrı İnaçları Anketi puanları arttıkça, dinlenme (GASdinlenme)ve aktivite (GASaktivite) sırasında ağrı şiddedileri azaldı (p<0,05). GASdinlenme ile ABÇÖ’nin sadece Tıbbi Çare Arama alt parametresi arasında (p=0,008), GASaktivite ile ABÇÖ’nin sadece Çaresizlik altparametresi arasında pozitif ve anlamlı bir korelasyon vardı (p<0,05). GASaktivite ve GASdinlenme ile KKİA puanları arasında pozitif ve anlamlı ilişkili olduğu görüldü (p<0,05). Regresyon analizi sonuçları, ağrı ile ilgili psikolojik inançların GASdinlenme (p=0,014) ve GASaktivite (p=0,006) ‘nin temel belirleyicisi olduğunu göstermiştir. Ağrı ile ilgili organik inançlar, GASdinlenme (p=0,019) ve GASaktivite (p=0,031) üzerinde anlamlı ancak daha düşük etkiye sahip olduğu gözlemlendi. İstirahat halinde ağrı için ilaç almanın GAS pualarını düşürmede anlamlı etkisi olduğu görüldü (p=0,024).
SONUÇ: Ağrı ile ilişkili olumsuz inançların yönetimindeki yetersizlikler, istirahatte bile ağrının şiddetlenmesine katkıda bulunmaktadır. Ancak ağrı için geliştirilen tıbbi tedaviler dışında ne korkudan kaçınma davranışı ne de ağrı ile başa çıkma stratejileri ağrı şiddetini azaltmamaktadır.

Keywords

Bel ağrısı, İnançlar, Başa çıkma stratejileri, Korkudan kaçınma, Psikososyal faktörler.

References

• 1. Hajihasani A, Rouhani M, Salavati M, et al. 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. American Academy of Physical Medicine and Rehabilitation. 2019;12:167-76.
• 2. Huysmans E, Leemans L, Beckwée D, et al. The relationship between cognitive and emotional factors and healthcare and medication use in people experiencing pain: a systematic review. Journal Of Clinical Medicine. 2020;9:2486.
• 3. Gorczyca R, Filip R, Walczak E. Psychological aspects of pain. Ann Agric Environ Med. 2013;1:23-27.
• 4. Rolving N, Oestergaard LG, Willert MV. et al. Description and design considerations of a randomized clinical trial investigating the effect of a multidisciplinary cognitive-behavioural intervention for patients undergoing lumbar spinal fusion surgery. BMC Musculoskeletal Disorders. 2014;15:1-8.
• 5. Dansie EJ, Turk, DC. Assessment of patients with chronic pain. British Journal Of Anaesthesia. 2013;111:19-25.
• 6. Caneiro JP, Bunzli S, O'Sullivan P. Beliefs about the body and pain: the critical role in musculoskeletal pain management. Brazilian Journal Of Physical therapy. 2021;25:17-29.
• 7. Ballús-Creus C, Rangel MV, Peñarroya A, et al. Expressed emotion among relatives of chronic pain patients, the interaction between relatives’ behaviours and patients’ pain experience. International Journal of Social Psychiatry. 2014;60:197-205.
• 8. Esteves JE, Wheatley L, Mayall, et al. Emotional processing and its relationship to chronic low back pain: Results from a case-control study. Manual Therapy. 2013;18:541-46.
• 9. Alaca N, Kaba H, Atalay A. Associations between the severity of disability level and fear of movement and pain beliefs in patients with chronic low back pain. Journal of Back and Musculoskeletal Rehabilitation. 2022;33:785-91.
• 10. La Touche R, Pérez-Fernández M, Barrera-Marchessi I, et al. Psychological and physical factors related to disability in chronic low back pain. Journal of Back and Musculoskeletal Rehabilitation. 2019; 32:603-11.
• 11. Coulombe BJ, Kenneth EG, Elizabeth RN, et al. Core stability exercise versus general exercise for chronic low back pain. Journal Of Athletic Training. 2017;52:71-72.
• 12. Edwards LC, Pearce SA, Turner-Stokes L. Et al. The Pain Beliefs Questionnaire: An Investigation of Beliefs In The Causes and Consequences of Pain. Pain.1991;51 (3):267-72.
• 13. Topcu SY. Relations among pain, pain beliefs, and psychological well-being in patients with chronic pain. Pain Management Nursing. 2018;19:637-44.
• 14. Sertel Berk HO. The Experience of Chronic Pain and Pain Beliefs: The Turkish Validation of the Pain Beliefs Questionnaire. Doktora tezi. Istanbul: İstanbul Universitesi Sosyal Bilimler Enstitüsü, Psikoloji Anabilim Dalı, 2006.
• 15. Kleinke CL. How chronic pain patients cope with pain: Relation to treatment outcome in a multidisciplinary pain clinic. Cognitive Therapy and Research. 1992;16:669-85.
• 16. Karaca S, Demir O, Aşkın R, et al. Ağrı ile Başa Çıkma Ölçeği Geçerlilik ve Güvenirliği. 5. Türk-Alman Fiziksel Tıp ve Rehabilitasyon Kongresi. Antalya, 1996.
• 17. Gülnar E, Özveren H, Tüzer H, et al. An Investigation of Pain Beliefs, Pain Coping, and Spiritual Well-Being in Surgical Patients. Journal of Religion and Health. 2021;1:11.
• 18. Waddell G, Newton M, Henderson I, et al. A FearAvoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low-back pain and disability. Pain. 1993;52:157–68.
• 19. Özcan BÖ, Baş Aslan U. Korku-Kaçınma İnanışlar Anketi’nin Türkçe’ye uyarlanması, güvenirliği ve geçerliği. Fizyoter Rehabil. 2013;24:135-43.
• 20. McGorry RW, Shaw WS, Lin, JH. Correlations between pain and function in a longitudinal low back pain cohort. Disability and Rehabilitation. 2011; 33:945-952.
• 21. Lin I, Wiles L, Waller R, et al. What does best practice care formusculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematicreview. Br J Sports Med. 2020;54(2):79-86.
• 22. Vibe FK, Smith AK, Skouen JS. et al. Cognitive functional therapy in patients with non‐specific chronic low back pain a randomized controlled trial 3‐year follow‐up. European Journal of Pain. 2019;23:1416-24.
• 23. Turk DC, Monarch ES. Biopsychosocial perspective on chronic pain. Psychological approaches to pain management: a practitioner’s handbook. New York, 2002.
• 24. Yoshimoto T, Oka H, Katsuhira J. et al. Prognostic psychosocial factors for disabling low back pain in Japanese hospital workers. PLoS One. 2017;12:0177908.
• 25. Matsudaira K, Kawaguchi M, Isomura T, et al. Assessment of psychosocial risk factors for the development of non-specific chronic disabling low back pain in Japanese workers- findings from the Japan Epidemiological Research of Occupation-related Back Pain study. Ind Health. 2015;53:368-77.
• 26. Hirsch O, Strauch K, Held H, et al. Low back pain patient subgroups in primary care: Pain characteristics, psychosocial determinants, and health care utilization. Clinical Journal Pain. 2014;30:1023–32.
• 27. Christe G, Pizzolato V, Meyer M. et al. Unhelpful beliefs and attitudes about low back pain in the general population: A cross-sectional survey. Musculoskeletal Science and Practice. 2021;52:102-342.
• 28. Lim YZ, Chou L, Au RT, et al. People with low back pain want clear, consistent and personalised information on prognosis, treatment options and self-management strategies: a systematic review. Journal of Physiotherapy. 2019;65:124-35.
• 29. Hajihasani A, Rouhani M, Salavati M. et al. 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;11:167-76.
• 30. Wertli MM, Rasmussen-Barr E, Weiser S, et al. 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: 816-36.
• 31. Nava Bringas TI, Macías-Hernández SI, Vásquez-Ríos JR, et al. Fear-avoidance beliefs increase perception of pain and disability in Mexicans with chronic low back pain. Revista Brasileira de Reumatologia. 2017; 57:306-10.