Disability in Acute Low Back Pain: The Role of Pain Severity,

Pain Catastrophizing, Depression, and Exercise

Background/Purpose: The effectiveness of cognitive treatments for low back pain, a prevalent and costly condition, are commonly based on the principles of the Vlaeyen Fear of Movement/(Re) Injury Model. In this model, persons with a painful injury/experience who also engage in pain catastrophizing are most likely to avoid activity leading to disability. The validation of this model in patients suffering from acute low back is limited. The purpose of this project is to describe whether level of disability is associated with variables identified in the Fear of Movement/(Re) Injury Model, including pain, pain catastrophizing, depression, and exercise in persons with acute low back pain.

Methods: Linear regression was used to assess the association of disability (total score, Roland Morris Disability Scale, range=0-24) with exercise (Yes/No), pain catastrophizing (total score, Pain Catastrophizing Scale, range=0-52), depression (total score, Center for Epidemiologic Studies Depression, range=20-80), and pain intensity (Brief Pain Inventory intensity score, range=0-40) at baseline among subjects with acute low-back pain (N=39) participating in a randomized clinical trial to prevent transition to chronic low-back pain.

Results:   Over half (52%) of our predominantly female (82%) sample worked full-time and their average age was 53 years (standard deviation=11.6). Controlling for age, gender, and work status (working full-time or not), the overall model was significant for disability (R²=.73, F[7,39] = 12.06; p<.0001), with an adjusted R² of 0.73. Predicted disability was higher by .46 points per 1-point higher score on pain catastrophizing (p=.002) and higher by .51 points per 1-point higher score on pain severity (p<.0001). Exercise and depression were not significant predictors of disability.

Conclusion: Findings from this study suggest that pain catastrophizing and pain were significant correlates of disability in this sample of persons with acute low back pain. These findings suggest that the application of the Fear of Movement/(Re) Injury Model to this population is appropriate and that there is likely clinical utility to the use cognitive therapy. In turn, effectively treating patients during the acute phase of this condition might prevent the transition to a chronic low back pain state.