The relation between cognitive factors and levels of pain and disability in chronic low back pain patients presenting for physiotherapy

Abstract

The aim of this study was to determine the extent to which a number of distinct cognitive factors were differentially related to the levels of pain and disability reported by 183 chronic low back pain (CLBP) patients presenting for physiotherapy. After adjusting for demographics, the cognitive factors accounted for an additional 30% of the variance in pain intensity, with functional self-efficacy (beta=-0.40; P<0.001) and catastrophizing (beta=0.21; P<0.01) both uniquely contributing to the prediction of outcome. The cognitive factors also explained an additional 32% of the variance in disability after adjusting for demographics and pain intensity (total R(2)=0.61). Higher levels of functional self-efficacy (beta=-0.43; P<0.001) and lower levels of depression (beta=0.23; P<0.01) were uniquely related to lower levels of disability. Our findings clearly show that there is a strong association between cognitive factors and the levels of pain and disability reported by CLBP patients presenting for physiotherapy. Functional self-efficacy emerged as a particularly strong predictor of both pain intensity and disability. In view of our findings it would seem that targeting specific cognitive factors should be an integral facet of physiotherapy-based treatments for CLBP.

Interventional pain medicine: retreat from the biopsychosocial model of pain

“…In general, studies indicate that higher SE for pain shares a positive relation with functional ability and adjustment to chronic pain [146][147][148], and mediates the relation between pain and disability [149], pain and depression [150], and life stress and headache [151]. Clinical investigations indicate that SE for pain is associated with lower pain intensity [148,152], and less severe pain-related distress and disability [95,153,154]. In prospective studies, SE predicts outcomes for post-surgical pain rehabilitation [144,155].…”

“…Research studies describing treatment outcome for multidisciplinary pain rehabilitation [94] and less comprehensive physiotherapy programs [95] attest to the predictive value of psychosocial factors in contributing to the outcomes of these interventions. More pertinent to IPM, there is a vast literature on the study and benefit of psychosocial assessment for predicting surgical outcomes and identifying patient risk factors for disappointing surgical results [92,96,97].…”

Disability and Health Outcomes – From a Cohort of People on long term ART

“…A poorer state of health is often directly associated with a decreased level of function in the general population [39,40]. In addition, adherence to ARVs has been shown to improve overall health status of PLHIV [36,38].…”

Crenças em relação às condições crônicas de saúde: uma revisão crítica de instrumentos adaptados para a língua portuguesa

“…Estudos têm investigado a infl uência de fatores cognitivos sobre a experiência dolorosa de uma pessoa (1). Fatores cognitivos são defi nidos como sentimentos ou expectativas de alguém sobre o signifi cado de sua dor; são crenças em relação à habilidade no controle da própria dor (2).…”

“…Um estudo de natureza correlacional investigou a infl uência dos fatores cognitivos em indiví-duos com lombalgia crônica e concluiu que medo do movimento, catastrofi zação e, principalmente, baixa autoefi cácia foram preditores de dor, incapacidade e depressão (1). Confi rmando estes achados, Turner et al (6) analisaram fatores cognitivos como mediadores de crenças na dor crônica temporomandibular e evidenciaram que autoefi cácia e crenças e atitudes diante da dor foram preditores independentes de dor e incapacidade.…”