Chronic low back pain and the risk of depression or anxiety symptoms: insights from a longitudinal twin study

Fernandez, Matthew; Colodro‐Conde, Lucía; Hartvigsen, Jan; Ferreira, Manuela L; Refshauge, Kathryn M.; Pinheiro, Marina B.; Ordoñana, Juan R.; Ferreira, Paulo H.

doi:10.1016/j.spinee.2017.02.009

Cited by 79 publications

(55 citation statements)

References 47 publications

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“…12 While chiropractors are trained and educated in the diagnosis and management of a broad range of musculoskeletal conditions, 13 they are also recognised as advocates for active lifestyle, general wellness and health promotion, 12,[14][15][16] with at least 90% prescribing or advising on physical activity or exercise in their consultations. 12,14,[17][18][19][20] People seeking chiropractic care for back complaints are also more likely to have poorer health and report several chronic diseases, [21][22][23] compared to the general population. 3 Evidence suggests the implementation of physical activity interventions has a favourable impact on pain severity, mental health, physical functioning 24 and chronic diseases 25 while at the same time is unlikely to cause any adverse effects.…”

Section: Introductionmentioning

confidence: 99%

The prevalence and determinants of physical activity promotion by Australian chiropractors: A cross sectional study

Fernandez

Moore

Eklund

et al. 2019

Complementary Therapies in Medicine

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Background: Approximately one in four adults do not meet the World Health Organisation physical activity recommendations. While health promotion (i.e., physical activity) is common within chiropractic settings, little is known about chiropractors discussing this public health issue with their patients. The aim of our study is to examine the prevalence and characteristics of Australian chiropractors who frequently discuss patient physical activity. Methods: A national cross-sectional survey of chiropractors focusing upon practitioner characteristics, practice settings and clinical management characteristics. Regression analyses were conducted on 1924 survey respondents to identify factors associated with practitioners who frequently discuss physical activity with patients. Results: Eighty-five percent of Australian chiropractors reported 'often' discussing physical activity as part of their patient management. The strongest factors associated with chiropractors who frequently discuss physical activity obtained from the multivariate analysis include: often discussing occupational health and safety (odds ratio [OR] = 6.10; 95%CI: 3.88, 9.59), often discussing diet/nutrition (OR = 4.56; 95%CI: 3.12, 6.66), often discussing smoking/drugs/alcohol (OR = 4.41; 95%CI: 2.06, 9.40), often use of specific exercise therapy/rehabilitation/injury taping (OR = 3.76; 95%CI: 2.62, 5.39) and often caring for athletes or sports people (OR = 2.18; 95%CI: 1.56, 3.06) within their practice setting. Conclusion: Discussing physical activity is a frequent feature of patient management among most chiropractors in Australia. The association between these practitioners and discussion of other costly public health burdens could suggest chiropractors have a valuable role to play in chronic disease prevention. Given the growing need for practitioner-led promotion of patient physical activity further research examination of the role and contribution of chiropractors in promoting this important public health topic among patients and communities is needed.

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Section: Introductionmentioning

confidence: 99%

The prevalence and determinants of physical activity promotion by Australian chiropractors: A cross sectional study

Fernandez

Moore

Eklund

et al. 2019

Complementary Therapies in Medicine

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“…Several population-based studies have investigated such a longitudinal association between pain and symptoms of depression [1,12,18] and of anxiety [1,12]. In non-depressed subjects, those with moderate to severe interference due to pain [1], more severe pain [18], and chronic low back pain [12] were more likely to report depressive symptoms at follow-up, compared to those without pain. In nonanxious subjects, the same results were found for moderate to severe interference due to pain [1] and chronic low back pain [12].…”

Section: Introductionmentioning

confidence: 99%

“…In non-depressed subjects, those with moderate to severe interference due to pain [1], more severe pain [18], and chronic low back pain [12] were more likely to report depressive symptoms at follow-up, compared to those without pain. In nonanxious subjects, the same results were found for moderate to severe interference due to pain [1] and chronic low back pain [12]. After adjusting for affective disorder at baseline, the strength of the painaffect associations was weakened [1], suggesting they modify each other's association with pain.…”

Section: Introductionmentioning

confidence: 99%

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Pain as a risk factor for common mental disorders. Results from the Netherlands Mental Health Survey and Incidence Study-2: a longitudinal, population-based study

Heer

Have

Marwijk

et al. 2017

Pain

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Pain might be an important risk factor for common mental disorders. Insight into the longitudinal association between pain and common mental disorders in the general adult population could help improve prevention and treatment strategies. Data were used from the first 2 waves of the Netherlands Mental Health Survey and Incidence Study-2, a psychiatric epidemiological cohort study among the Dutch general population aged 18 to 64 years at baseline (N = 5303). Persons without a mental disorder 12 months before baseline were selected as the at-risk group (n = 4974 for any mood disorder; n = 4979 for any anxiety disorder; and n = 5073 for any substance use disorder). Pain severity and interference due to pain in the past month were measured at baseline using the Short Form Health Survey. DSM-IV mental disorders were assessed at both waves using the Composite International Diagnostic Interview version 3.0. Moderate to very severe pain was associated with a higher risk of mood (odds ratio [OR] = 2.10, 95% confidence interval [CI] = 1.33-3.29) or anxiety disorders (OR = 2.12, 95% CI = 1.27-3.55). Moderate to very severe interference due to pain was also associated with a higher risk of mood (OR = 2.14, 95% CI = 1.30-3.54) or anxiety disorders (OR = 1.92, 95% CI = 1.05-3.52). Pain was not significantly associated with substance use disorders. No interaction effects were found between pain severity or interference due to pain and a previous history of mental disorders. Moderate to severe pain and interference due to pain are strong risk factors for first-incident or recurrent mood and anxiety disorders, independent of other mental disorders. Pain management programs could therefore possibly also serve as a preventative program for mental disorders.

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“…52 To our knowledge, this is the first longitudinal co-twin control study to show a significant association between a psychological risk factor and incident back pain in sizes. 22,23 Another potential limitation of the longitudinal co-twin control design using binary outcomes is the typical practice of restricting the baseline sample to twin pairs where both co-twins do not have the outcome at baseline, as was done in our study.…”

Section: Two Prior Longitudinal Studies In Clinical Samples Of Patienmentioning

confidence: 99%

Post-traumatic Stress Disorder Symptoms are Associated With Incident Chronic Back Pain

Suri

Boyko

Smith

et al. 2019

Spine

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Study Design: Longitudinal co-twin control study of the Vietnam-Era Twin Registry. Objective: To examine the association of post-traumatic stress disorder (PTSD) symptoms with incident chronic back pain (CBP), while controlling for genetic factors and early family environment. Summary of Background Data: It is unknown whether PTSD symptoms are associated with an increased incidence of CBP. Methods: In 2010-2012 a baseline survey was undertaken as part of a large-scale study of PTSD. Study participants completed the PTSD Symptom Checklist (PCL) and a self-report measure of CBP. In 2015-2017 a follow-up survey was sent to all 171 monozygotic (MZ) twin pairs (342 individuals) where both co-twins had no history of CBP at baseline, but only one co-twin in the pair met criteria for having current PTSD symptoms (one twin with PCL <30 and the co-twin with PCL≥30). No other inclusion/exclusion criteria were applied. CBP at 5-year follow-up was defined as back pain of duration ≥3 months in the low back or mid/upper back. Covariates included age, race, education, income, Veterans Affairs health care use, disability compensation, smoking, body mass index, and depression. Statistical analysis estimated the cumulative incidence of CBP according to baseline PTSD symptoms. Risk ratios (RRs) and 95% confidence intervals (CI) were estimated in matched-pair co-twin control analyses adjusting for familial factors.Results: Among 227 males completing 5-year follow-up, including 91 MZ twin pairs, the mean age was 62 years. Five-year incidence of CBP in those without and with baseline PTSD symptoms was 40% and 60%, respectively. Baseline PTSD symptoms were significantly associated with incident CBP in crude and multivariable-adjusted within-pair analyses (RR 1.6 [95% CI 1.2-2.1]; p=0.002).Conclusions: PTSD symptoms were associated with an increased incidence of CBP, without confounding by genetic factors or early family environment. PTSD symptoms may be a modifiable risk factor for prevention of CBP. KeyPoints• This is the first longitudinal co-twin control study of post-traumatic stress disorder (PTSD) and back pain. • The association of PTSD symptoms with incident chronic back pain at 5-year followup is independent of genetic and familial factors.• PTSD symptoms may be a modifiable risk factor for chronic back pain.

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Chronic low back pain and the risk of depression or anxiety symptoms: insights from a longitudinal twin study

Cited by 79 publications

References 47 publications

The prevalence and determinants of physical activity promotion by Australian chiropractors: A cross sectional study

The prevalence and determinants of physical activity promotion by Australian chiropractors: A cross sectional study

Pain as a risk factor for common mental disorders. Results from the Netherlands Mental Health Survey and Incidence Study-2: a longitudinal, population-based study

Post-traumatic Stress Disorder Symptoms are Associated With Incident Chronic Back Pain

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