Catastrophizing and Pain Expectations Related to Time with Nonspecific Back Pain

Spinal pain, or back pain, is very common in the Western world. In fact, it affects up to 80 percent of people at least one time in their life. Usually, the pain is nonspecific, not caused by any particular trauma or injury, or there isn't any body part or tissue that has been noticeably injured.

Most often, nonspecific back pain goes away after three to 12 months, although most people do end up having more back pain later. And, among those people, an average of 16 percent experience back pain that's bad enough to affect their every day life. This means the majority of people with nonspecific back pain don't usually have any long-term problems and don't even seek medical help.

Many studies have been done that have helped doctors understand things like catastrophizing (feeling that things worse than they really are), depression and feeling badly about oneself as a result of chronic pain. It's been found that the amount of psychological distress felt by a patient affects how the patient feels pain and reacts to it. It can also predict how pain will be perceived. Other studies have been done to find how the length or duration of pain relates to disability, as well as pain and psychological status. Some of these studies have suggested that if someone is experiencing pain for 12 weeks or more, they should be watched for psychological effects from the pain. This is because it's been found that most major improvements related to back pain occur during the first three months of pain.

Despite the many studies that have been done on back pain, not much has been done on the cognitive (thoughts and mental processes), physical, behavioral, and environmental factors that may play a role in how long nonspecific back pain stays. The authors of this article wanted to study thesevariables. Since most people with nonspecific back pain don't seek help from their doctor, the researchers had to reach out to the community for study participants. To do this, they sent out questionnaires to 5000 adults, aged from 20 to 50 years, on a random basis.

To participate in the survey, the respondents must not have had a herniated disc (also called bulging disc or slipped disc), any rheumatic diseases (such as lupus or rheumatoid arthritis), fibromyalgia, or whiplash, nor could the women be pregnant. a total of 1815 people returned their completed questionnaire and 1024 complained that they had nonspecific back pain some time over the previous year.

More women than men complained of back pain (54 percent women). The group was broken down into three age groups. Those between 31 to 40 years made up 35.8 percent of the group; 41 to 50 years made up 35.5 percent, and the younger group, aged 20 to 30 years, made up 28.6 percent. Only 51.9 percent of the group had seen a doctor about the back pain.

The patients were asked to grad their back pain on the Graded Chronic Pain Scale, which has four categories: 1: low pain, low interference with life activities; 2: high pain intensity but low interference; 3: high interference that was moderately limiting activities; and 4: high interference that was severely limiting. The majority of the group, 85 percent, responded with 1 or 2.

The group was also divided into four categories describing their situation: 1: 100 reported that this was first time they've had back pain for less than three months (short-term); 2: 215 reported that this was repeat of short-term back pain; 3: 172 said their pain was present for more than three months but less than a year (medium-term back pain); and 4: 537 complained of pain for more than a year (long-term pain).

To get an idea of how the patients felt about their pain, the questionnaires asked questions about work satisfaction, pain vigilance, prevention or decreases in pain, how patients confronted their pain, if they did physically demanding work, their expectations about their pain, if they exercised, and if they did every day exercise.

In gathering the results, the researchers found that there were small but important differences between the groups regarding depression, catastrophizing, and pain expectation. There also may have been a difference in how they perceived social support (family, friends, employers). Patients who were in the groups of having longer periods of pain also had higher levels of catastrophizing and pain expectations. Those with long-term pain (longer than a year) also felt they had low social support. The article's authors wrote that it wasn't unexpected that "groups with longer pain duration expect pain to continue to a greater extent than groups with short-term pain, as individuals learn from their experience."

Ingrid Demmelmaier, RT, et al. The Associations Between Pain Intensity, Psychosocial Variables, and Pain Duration/Recurrence in a Large Sample of Persons with Nonspecific Spinal Pain. InThe Clinical Journal of Pain. September 2008. Vol. 24. Pp. 611-619.

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