Relationships Between Psychological, Social, Physical Activity, and Sleep Measures and Somatosensory Function in Individuals With Spinal Pain

Abstract

Objective: Somatosensory abnormalities are linked to clinical pain outcomes in individuals with spinal pain. However, a range of factors might confound the relationship between altered somatosensory function and clinical pain outcomes. This systematic review aimed to evaluate the literature to assess the level of evidence of associations between psychological, social, physical activity, and sleep measures and somatosensory function (assessed via sensory psychophysical testing) among individuals with spinal pain. Methods: A comprehensive literature search was performed in 6 electronic databases from their inception to June 2018. Two reviewers independently assessed the methodological quality using a modified Quality in Prognostic Studies (QUIPS) tool and supplemented with recommendations from the Critical Appraisal and Data Extraction for the Systematic Review of Prediction Modelling Studies (CHARMS) checklist and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The level of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. Data were pooled to evaluate the strength of the relationships of interest. Results: Among the 17 factors identified in the included studies, pain catastrophizing, depression, and pain-related fear have significant negative (small to fair) associations with pain thresholds. A “very low” to “moderate” quality of evidence was found for all the investigated factors. Subgroup analysis showed a smaller effect size for pain catastrophizing/fear of movement and pain thresholds in individuals with low back pain. Conclusions: Psychological factors are associated negatively with pain thresholds and they need to be adjusted when establishing predictive relationships between somatosensory function and pain outcomes in individuals with spinal pain.

Quantitative Sensory Testing Discriminates Central Sensitization Inventory Scores in Participants with Chronic Musculoskeletal Pain: An Exploratory Study

“…Studies on the relationship between QST and psychosocial variables have largely yielded low associations in heterogeneous populations, with catastrophizing showing some of the strongest correlations 30 . Catastrophizing and anxiety have each been shown to be associated with heat pain threshold in adults with chronic pain 50 .…”

“…Patients with LBP who display a nociceptive mechanism may present with QST profiles more similar to normal controls, whereas subjects with a CS mechanism may display many of the aforementioned QST characteristics associated with CS. Also, it is worth noting that psychological variables such as anxiety and depression have a small, negative association with pain thresholds, so these should be accounted for when predicting outcomes using QST measures in patients with spinal pain 30 …”

Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine

“…71 The absence of predictive ability of QST findings in some studies can be explained by the moderating effects of psychosocial and lifestyle factors, such as sleep and physical activity. 72 A systematic review and metaanalysis in April 2018 that included 37 studies and 3860 participants with musculoskeletal diseases concluded that baseline QST measures of central sensitisation predicted major outcomes such as pain (mean r 0•31, 95% CI 0•23-0•38; n=1057) and disability (mean r 0•30, 95% CI 0•19-0•40; n=290). 73 Baseline temporal summation (mean r 0•37, 95% CI 0•17-0•54) and conditioned pain modulation (mean r 0•36, 95% CI 0•20-0•50) were also associated with pain at followup.…”

Psychological Interventions for the Treatment of Chronic Pain in Adults

“…In particular, psychological factors such as mental health problems (e.g., depression, anxiety) are associated with poor sleep (Finan et al, 2013;Vincent et al, 2015). Catastrophizing, as well, has been associated with reduced sleep quality (Othman et al, 2019). Reviews of the biopsychosocial model of pain have generally highlighted interrelationships between sleep and psychological factors such as distress, and some reviews have suggested that sleep disruption is a critical pathway by which negative affective processes affect long-term pain outcomes (Buenaver et al, 2012;Edwards et al, 2006Edwards et al, , 2011Finan et al, 2013).…”