Negative beliefs about low back pain are associated with persistent high intensity low back pain

While previous cross-sectional studies have found that negative beliefs about low back pain are associated with pain intensity, the relationship between back beliefs and persistent low back pain is not well understood. This cohort study aimed to examine the role of back beliefs in persistent low back pain in community-based individuals. A hundred and ninety-two participants from a previous musculoskeletal health study were invited to take part in a two-year follow-up study. Beliefs about back pain were assessed by the Back Beliefs Questionnaire (BBQ) at baseline and low back pain intensity was measured by the Chronic Pain Grade Questionnaire at baseline and follow-up. Of the 150 respondents (78.1%), 16 (10.7%) reported persistent high intensity low back pain, 12 (8.0%) developed high intensity low back pain, in 16 (10.7%) their high intensity low back pain resolved and 106 (70.7%) experienced no high intensity low back pain. While participants were generally positive about low back pain (BBQ mean (SD) = 30.2 (6.4)), those with persistent high intensity pain reported greater negativity (BBQ mean (SD) = 22.6 (4.9)). Negative beliefs about back pain were associated with persistent high intensity low back pain after adjusting for confounders (M (SE) = 23.5 (1.6) vs. >30.1 (1.7), p < .001). This study found negative back beliefs were associated with persistent high intensity low back pain over 2 years in community-based individuals. While further longitudinal studies are required, these findings suggest that targeting beliefs in programs designed to treat and prevent persistent high intensity low back pain may be important.     

The role of additional information in the compliance,satisfaction, psychological,and emotion responses of non-surgical patients with low back pain: An exploratory investigation

Abstract

Noncompliance and the psychological and emotional states of patients with low back pain are major concerns for health professionals. The current study evaluated whether amount of information available to patients enhanced compliance to a medical regimen and whether it reduced negative emotions in patients with low back pain. Forty-five orthopaedic non-surgical patients with low back pain were randomly assigned to one of three information presentation conditions: 1) Standard, 2) Pre-examination, and 3) Post-examination. Patients were also separated by compensation and noncompensation within each information group. Patients completed questionnaires at their initial visit and at their follow-up which evaluated their: levels of compliance to a prescribed treatment program, psychological, and emotional states. Results indicated that some patients benefitted from receiving additional information as the Pre-examination and Post-examination groups demonstrated superior comprehension and recall as well as higher levels of compliance to a physical therapy program. In addition, compensation patients complained of more negative psychological and emotional behaviors in comparison to noncompensation patients. Implications of the research and future research considerations were discussed.     

Stiffness properties of the trunk in people with low back pain

The purpose of this study was to examine the dynamic properties of the trunk during unstable sitting and to determine differences between healthy and low back pain (LBP) participants.Participants sat on a custom-made chair that was able to swing freely in the sagittal plane. The chair was mounted on a force platform to measure loads acting at the trunk. Each participant was asked to find a balanced position after the chair was tilted backward and released. Movements of the trunk and chair were recorded. Effective moment of inertia, stiffness and damping coefficients were derived using a second order linear model. 10 participants were re-tested to assess reliability.Trunk stiffness was found increased for LBP subjects (p < .05) while no difference was found for damping coefficient. Gender and initial tilt angle did not affect viscoelastic properties of the spine.A second order linear model adequately described the biomechanical response of the trunk. It was shown that the trunk response was mainly elastic for all participants. The increase in trunk stiffness in LBP subjects could be a compensatory strategy to decrease pain and the risk of further injuries, but further investigations are needed to understand the nature of the viscoelastic alterations.     

Asymmetry of lumbopelvic movement patterns during active hip abduction is a risk factor for low back pain development during standing

An induced-pain paradigm has been used in back-healthy people to understand risk factors for developing low back pain (LBP) during prolonged standing. We examined asymmetry of lumbopelvic movement timing during a clinical test of active hip abduction in back-healthy people who developed LBP symptoms during standing (Pain Developers; PDs) compared to back-healthy people who did not develop LBP symptoms during standing (Non Pain Developers, NPDs). Participants completed the hip abduction test while movement was recorded with a motion capture system. Difference in time between start of hip and lumbopelvic movement was calculated (startdiff). PDs moved the lumbopelvic region earlier during left hip abduction than right hip abduction. There was no difference between sides in NPDs. In PDs, the amount of asymmetry was related to average symptom intensity during standing. Asymmetric lumbopelvic movement patterns may be a risk factor for LBP development during prolonged standing.     

Task-related and person-related variables influence the effect of low back pain on anticipatory postural adjustments

BackgroundPeople with low back pain exhibit altered postural coordination that has been suggested as a target for treatment, but heterogeneous presentation has rendered it difficult to identify appropriate candidates and protocols for such treatments. This study evaluated the associations of task-related and person-related factors with the effect of low back pain on anticipatory postural adjustments.MethodsThirteen subjects with and 13 without low back pain performed seated, rapid arm flexion in self-initiated and cued conditions. Mixed-model ANOVA were used to evaluate group and condition effects on APA onset latencies of trunk muscles, arm-raise velocity, and pre-movement cortical potentials. These measures were evaluated for correlation with pain ratings, Fear Avoidance Beliefs Questionnaire scores, and Modified Oswestry Questionnaire scores.FindingsDelayed postural adjustments of subjects with low back pain were greater in the cued condition than in the self-initiated condition. The group with low back pain exhibited larger-amplitude cortical potentials than the group without pain, but also significantly slower arm-raise velocities. With arm-raise velocity as a covariate, the effect of low back pain remained significant for the latencies of postural adjustments but not for cortical potentials. Latencies of the postural adjustments significantly correlated with Oswestry and Fear Avoidance Beliefs scores.InterpretationDelayed postural adjustments with low back pain appear to be influenced by cueing of movement, pain-related disability and fear of activity. These results highlight the importance of subject characteristics, task condition, and task performance when comparing across studies or when developing treatment of people with low back pain.     

Failed back surgeries and minnesota multiphasic personality inventory (MMPI) profiles

MMPI profiles were evaluated for 105 prospective surgical patients who had previously undergone surgery or other procedures for treatment of back pain. Patients were classified into groups having undergone zero, one, two, three, or four or more previous surgeries. While all groups demonstrated a characteristicsomatogenic profile, none of the MMPI validity or clinical scales significantly differentiated the groups and there was no relationship between increased number of surgeries and MMPI scale characteristics. These results support the nonoptimistic prognostication of thesomatogenic MMPI profile for surgical intervention for back pain but show no clear relationship of MMPI profile characteristics to degree of experience of previously failed surgery.     

Effects of varied-stimulus exposure on overpredictions of pain and behavioural performance in low back pain patients

The main objective of the present study was to investigate the benefits of exposure to a variety of movements versus exposure to the same movements on overprediction of pain and behavioural performance on a final behavioural test in a sample of chronic low back pain (CLBP) patients. Eighty-four CLBP patients were requested to perform four behavioural tests. Patients were assigned to two experimental conditions. The final behavioural test was the same for all patients. The first three behavioural tests consisted of three different movements in condition 1 and of three times the same movement in condition 2. During each behavioural test, baseline pain, expected pain and experienced pain were recorded. Furthermore, the peak torque and the variability of the produced muscle strength during the final behavioural test were assessed. Replicating and extending previous research, we found that patients overpredicted pain during a threatening behavioural test. Furthermore, pain-related fear and pain catastrophizing showed to be unique predictors of the peak torque of the final behavioural test. No support was found for our hypothesis that varied exposure facilitates generalization of exposure effects. Possible reasons for the failure to find an advantageous effect of varied-stimulus exposure and ideas for future research are discussed.     

Use of verbal pain measurement in the detection of hidden psychological morbidity among low back pain patients with objective organic findings

Abstract

Patients with positive physical findings to explain low back pain arc believed lo belong to two organic subgroups. One group has organic disease alone: in the other, organic disease is accompanied by psychological disturbance. Separation of patients with medical findings into groups with varying levels of psychological disturbance is difficult, because emotional disturbance is often hidden. In this study, the pain report of 124 patients with organic findings alone, and 50 patients with organic and psychological findings was examined to determine whether pain measurement could he used to identify accurately patients belonging 10 the two groups. the pain groups differed in the use of 43 pain words from the Low Back Pain Symptom Check List. Using a set of weights derived From discriminant analysis. the 33 pain words predicted 99.2% of the patients with organic disease alone and 86.0% of the patients with organic disease and psychological disturbance. The results were replicated in a new sample of 140 patients. Cross-validation shrinkage in accuracy was 8.3%. The results of the two studies suggest that pain measurement may he a useful clinical indicator of psychological disturbance in patients with organic findings.     

Comparison of the trunk-pelvis and lower extremities sagittal plane inter-segmental coordination and variability during walking in persons with and without chronic low back pain

Inter-segmental coordination can be influenced by chronic low back pain (CLBP). The sagittal plane lower extremities inter-segmental coordination pattern and variability, in conjunction with the pelvis and trunk, were assessed in subjects with and without non-specific CLBP during free-speed walking. Kinematic data were collected from 10 non-specific CLBP and 10 non-CLBP control volunteers while the subjects were walking at their preferred speed. Sagittal plane time-normalized segmental angles and velocities were used to calculate continuous relative phase for each data point. Mean absolute relative phase (MARP) and deviation phase (DP) were derived to quantify the trunk-pelvis and bilateral pelvis-thigh, thigh-shank and shank-foot coordination pattern and variability over the stance and swing phases of gait. Mann-Whitney U test was employed to compare the means of DP and MARP values between two groups (same side comparison). Statistical analysis revealed more in-phase/less variable trunk-pelvis coordination in the CLBP group (P < 0.05). CLBP group demonstrated less variable right or left pelvis-thigh coordination pattern (P < 0.05). Moreover, the left thigh-shank and left shank-foot MARP values in the CLBP group, were more in-phase than left MARP values in the non-CLBP control group during the swing phase (P < 0.05). In conclusion, the sagittal plane lower extremities, pelvis and trunk coordination pattern and variability could be generally affected by CLBP during walking. These changes can be possible compensatory strategies of the motor control system which can be considered in the CLBP subjects.     

Social and medical influences on attributions and evaluations of chronic pain

Abstract

Previous research suggests that judgments of pain are subject to social influences, including characteristics of the person in pain, the judge, and the social context in which the judgment occurs. In this experiment, eight vignettes describing a person with chronic low back pain were varied as a function of patient ethnicity (Caucasian vs African-American), litigation status (litigant vs non-litigant), and medical evidence (strong vs weak). Participants (N= 116) read vignettes, made attributions of causality for the person's pain and disability, and evaluated the severity of the pain syndrome. Pain and disability were perceived as more legitimate when the person in pain was a non-litigant and when medical evidence was strong. Evaluations of syndrome severity were more extreme when evidence was strong. A three-way interaction indicated that judgments may have been influenced by ethnic stereotypes. These findings substantiate the influence of social variables in judgments of persons with pain.     

The reluctance to generalize corrective experiences in chronic low back pain patients: a questionnaire study of dysfunctional cognitions

The present study investigated whether pain catastrophizing and pain-related fear is related to a reluctance to generalize an experience of lesser pain than expected to other similar situations. Eighty-five patients with chronic low back pain (40 males; 45 females; age range=21-63 years) completed a series of vignettes assessing catastrophizing, overgeneralization, personalization and selective abstraction related to general life experiences and to low back pain (LBP) experiences. Three vignettes also assessed the lack of generalization of corrective experiences related to LBP. Our results showed that dysfunctional cognitions related to general life experiences were the strongest predictor of the self-denigration subscale of the Beck Depression Inventory (BDI), whereas only dysfunctional cognitions related to LBP had a unique contribution in the prediction of the somatic and physical function subscale of the BDI. Furthermore, dysfunctional cognitions related to LBP were significantly correlated with interference with daily life due to pain. As predicted, pain catastrophizing and pain-related fear had a unique contribution in predicting the lack of generalization of corrective experiences, over and above sociodemogaphic variables, pain severity and pain duration.     

Psychological skills and mindfulness training effects on the psychological wellbeing of undergraduate music students: An exploratory study

This study explored the efficacy of psychological skills and mindfulness training intervention on the psychological wellbeing of undergraduate music students. Participants were undergraduate music students (n = 36) from the Department of Music at a South African university, 21 of whom were elected to take the psychological skills and mindfulness training intervention. Data on their self-reported psychological wellbeing, psychological skills, mindfulness and performance anxiety levels were collected pre-and post-intervention. The analysis applied non-parametric procedures to determine changes in students’ psychological wellbeing after the seven-week intervention programme. Findings suggest improvements in psychological wellbeing, psychological skills, mindfulness and performance anxiety with training. Psychological skills and mindfulness training may have benefits to the psychological wellbeing of music students.     

Psychological factors in hiv testing among sexually transmitted disease clinic patients: An exploratory study

Abstract

Substantial numbers of persons at risk for HIV infection do not seek HIV testing and factors influencing testing decisions are not well understood. To identify psychological characteristics of persons who remain unwilling to receive HIV testing, we surveyed patients of an inner-city sexually transmitted disease (STD) clinic (n = 181). Participants completed an anonymous survey and were grouped on the basis of HIV testing history and compared on measures of testing perceptions, attitudes, and decision making influences. Results showed that untested participants feared testing and had a sense of not knowing if they needed to be tested. In contrast, participants who were getting tested believed that testing would help them feel better about their health. Results also showed that participants lacked accurate information about some HIV testing procedures. We conclude that identifying concerns which inhibit seeking HIV testing can be useful in developing effective methods of promoting HIV testing.     

Local dynamic stability of the spine and its coordinated lower joints during repetitive Lifting: Effects of fatigue and chronic low back pain

The nonlinear Lyapunov exponent (LyE) has been proven effective for evaluating the local stability of human movement and exploring the effects of load, speed and direction of individuals with and without nonspecific chronic low back pain (CLBP). The purpose of this study was to examine spinal and lower joint stability and response to fatigue of individuals with and without CLBP while performing lifting-lowering movements. Fourteen healthy individuals and 14 patients with nonspecific CLBP were recruited to perform lifting movement repeatedly while holding two equally-sized dumbbells in their hands. The participants continued lifting until they reported their highest level of fatigue. Kinematic data for the spine and its coordinated lower joints were recorded during the task (more than 40 lifting cycles on average). The first and last 20 cycles of each cyclic time series were defined as early- and late-fatigue conditions, respectively. The maximum LyE was estimated to quantify the local dynamic stability of the angular displacement time series of the spine, hip, knee and ankle on different anatomical planes in both the early- and late-fatigue conditions. The results revealed that local stability of the spine and hip was affected by fatigue. Spinal stability decreased as fatigue increased on the sagittal plane (p < 0.05). The hip exhibited a similar affectation (destabilization under fatigue) on all anatomical planes. Patients with CLBP showed more stable hip movement on the frontal and transverse planes (p < 0.05). These results suggested that lifting/progressive fatigue could increase the risk of injury to the spine and hip. These findings indicate that patients with CLBP applied different control strategies for the hip; thus, spinal control stability should be evaluated together with the stability of the lower joints.     

The effect of chronic low back pain on tactile suppression during back movements

The aim of the present study was to examine whether tactile suppression, the phenomenon whereby tactile perception is suppressed during movement, would occur in the context of back movements. Of particular interest, it was investigated if tactile suppression in the back would be attenuated in those suffering from chronic low back pain. Individuals with chronic low back pain (N = 30) and a matched control group (N = 24) detected tactile stimuli on three possible locations (back, arm, chest) while performing a back or arm movement, or no movement. We hypothesized that the movements would induce tactile suppression, and that this effect would be largest for low-intense stimuli on the moving body part. We further hypothesized that, during back movements, tactile suppression on the back would be less pronounced in the chronic low back pain group than in the control group. The results showed the expected general tactile suppression effects. The hypothesis of back-specific attenuation of tactile suppression in the chronic low back pain group was not supported. However, back-specific tactile suppression in the chronic low back pain group was less pronounced in those who performed the back movements more slowly.     

基于心理痛苦理论与决策树的中学生心理危机分类模型

中学生心理危机分类模型属于复杂数据模型,本文采用分类树算法探究家庭、校园、同伴和个体因素在中学生心理危机分类中的相对重要性差异,尤其是心理痛苦三因素对致死性危机的独特作用。结果显示：（1）中学生自杀危机和非致死性危机分类树的分类效果良好,自伤危机分类树的分类效果欠佳;（2）中学生自杀危机中,痛苦逃避最为重要,痛苦唤醒次之,之后为痛苦体验和学校满意度;（3）中学生自伤危机中,同伴问题行为最为重要,之后为父母陪伴和家庭监督;（4）中学生非致死性危机中,歧视知觉最为重要,之后为痛苦唤醒和同伴支持。提示中学生不同心理危机的促发机制存在差异,心理痛苦三因素模型在自杀分类模型中作用显著,但并非自伤危机和非致死性危机的关键变量。     

The relationship of depression and somatic focus to experimental and clinical pain in chronic pain patients

Abstract

The present study examined Fields' proposal that depression increases the sensory experience of pain in part through greater somatic focus. Experimental and clinical pain measures were compared to self-report of depression and somatic focus in 60 chronic pain patients. Depression scores were unrelated to pain threshold or tolerance on the cold-pressor test. However, as hypothesized by Fields, path analytic models suggested that depression had a direct influence on the evaluative and affective aspects of pain, but the relationship between depression and sensory pain was mediated by somatic focus. These results provide partial support for Fields' neurobiological model of pain and depression.