Burden of Chronic Low Back Pain: Association With Pain Severity and Prescription Medication Use in Five Large European Countries

Abstract Objective For most patients with chronic low back pain (cLBP), the cause is “nonspecific,” meaning there is no clear association between pain and identifiable pathology of the spine or associated tissues. Laypersons and providers alike are less inclined to help, feel less sympathy, dislike patients more, suspect deception, and attribute lower pain severity to patients whose pain does not have an objective basis in tissue pathology. Because of these stigmatizing responses from others, patients with cLBP may feel that their pain is particularly unjust and unfair. These pain-related injustice perceptions may subsequently contribute to greater cLBP severity. The purpose of this study was to examine whether perceived injustice helps explain the relationship between chronic pain stigma and movement-evoked pain severity among individuals with cLBP. Methods Participants included 105 patients with cLBP who completed questionnaires assessing chronic pain stigma and pain-related injustice perception, as well as a short physical performance battery for the assessment of movement-evoked pain and physical function. Results Findings revealed that perceived injustice significantly mediated the association between chronic pain stigma and cLBP severity (indirect effect = 6.64, 95% confidence interval [CI] = 2.041 to 14.913) and physical function (indirect effect = −0.401, 95% CI = −1.029 to −0.052). Greater chronic pain stigma was associated with greater perceived injustice (P = 0.001), which in turn was associated with greater movement-evoked pain severity (P = 0.003). Conclusions These results suggest that perceived injustice may be a means through which chronic pain stigma impacts nonspecific cLBP severity and physical function.

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Reverse transformation of Modic Type 2 changes to Modic Type 1 changes during sustained chronic low-back pain severity

Journal of Neurosurgery Spine ◽

10.3171/spi.2007.6.2.152 ◽

2007 ◽

Vol 6 (2) ◽

pp. 152-155 ◽

Cited By ~ 28

Author(s):

Laurence A. G. Marshman ◽

Matthew Trewhella ◽

Tai Friesem ◽

Chandra K. Bhatia ◽

Manoj Krishna

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Reverse Transformation ◽

Pain Severity ◽

Low Back ◽

Modic Type ◽

Generating Capacity

✓Modic Type 2 (MT2) neuroimaging changes are considered stable or invariant over time and relatively quiescent, whereas Modic Type 1 (MT1) changes are considered unstable and more symptomatic. The authors report two cases in which MT2 changes were symptomatic and evidently unstable, and in which chronic low-back pain severity remained unaltered despite a MT2–MT1 reverse transformation. Two women (41 and 48 years old) both presented with chronic low-back pain. Magnetic resonance (MR) images demonstrated degenerating discs at L5–S1 associated with well-established MT2 changes in adjacent vertebrae. Repeated MR imaging in these two patients after 11 months and 7 years, respectively, revealed reverse transformation of the MT2 changes into more florid MT1 changes, despite unaltered chronic low-back pain severity. Following anterior discectomy and disc arthroplasty, immediate abolition of chronic low-back pain was achieved in both patients and sustained at 3-year follow up. Modic Type 2 changes are therefore neither as stable nor as quiescent as originally believed. Each type can change, with equal symptom-generating capacity. More representative imaging–pathological correlates are required to determine the precise nature of MT changes.

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Social Support is Inversely Associated with Sleep Disturbance, Inflammation, and Pain Severity in Chronic Low Back Pain

Nursing Research ◽

10.1097/nnr.0000000000000543 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Anitha Saravanan ◽

Prempreet Bajaj ◽

Herbert L. Mathews ◽

Dina Tell ◽

Angela Starkweather ◽

...

Keyword(s):

Social Support ◽

Low Back Pain ◽

Back Pain ◽

Sleep Disturbance ◽

Chronic Low Back Pain ◽

Pain Severity ◽

Low Back

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Functional Pain Severity and Mobility in Overweight Older Men and Women with Chronic Low-Back Pain—Part I

American Journal of Physical Medicine & Rehabilitation ◽

10.1097/phm.0b013e31828763a0 ◽

2013 ◽

Vol 92 (5) ◽

pp. 430-438 ◽

Cited By ~ 17

Author(s):

Heather K. Vincent ◽

Amanda N. Seay ◽

Cindy Montero ◽

Bryan P. Conrad ◽

Robert W. Hurley ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Older Men ◽

Pain Severity ◽

Low Back ◽

Men And Women ◽

Functional Pain ◽

Older Men And Women

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Biopsychosocial Profiles and Functional Correlates in Older Adults with Chronic Low Back Pain: A Preliminary Study

Pain Medicine ◽

10.1093/pm/pny065 ◽

2018 ◽

Vol 20 (7) ◽

pp. 1300-1310 ◽

Cited By ~ 4

Author(s):

Debra K Weiner ◽

Angela Gentili ◽

Katherine Coffey-Vega ◽

Natalia Morone ◽

Michelle Rossi ◽

...

Keyword(s):

Older Adults ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Gait Speed ◽

Cognitive Strategies ◽

Community Dwelling ◽

Pain Severity ◽

Low Back ◽

And Performance

Abstract Objective To describe key peripheral and central nervous system (CNS) conditions in a group of older adults with chronic low back pain (CLBP) and their association with pain severity and self-reported and performance-based physical function. Design Cross-sectional. Setting Outpatient VA clinics. Subjects Forty-seven community-dwelling veterans with CLBP (age 68.0 ± 6.5 years, range = 60–88 years, 12.8% female, 66% white) participated. Methods Data were collected on peripheral pain generators—body mass index, American College of Rheumatology hip osteoarthritis criteria, neurogenic claudication (i.e., spinal stenosis), sacroiliac joint (SIJ) pain, myofascial pain, leg length discrepancy (LLD), and iliotibial band pain; and CNS pain generators—anxiety (GAD-7), depression (PHQ-9), insomnia (Insomnia Severity Index), maladaptive coping (Fear Avoidance Beliefs Questionnaire, Cognitive Strategies Questionnaire), and fibromyalgia (fibromyalgia survey). Outcomes were pain severity (0 to 10 scale, seven-day average and worst), self-reported pain interference (Roland Morris [RM] questionnaire), and gait speed. Results Approximately 96% had at least one peripheral CLBP contributor, 83% had at least one CNS contributor, and 80.9% had both peripheral and CNS contributors. Of the peripheral conditions, only SIJ pain and LLD were associated with outcomes. All of the CNS conditions and SIJ pain were related to RM score. Only depression/anxiety and LLD were associated with gait speed. Conclusions In this sample of older veterans, CLBP was a multifaceted condition. Both CNS and peripheral conditions were associated with self-reported and performance-based function. Additional investigation is required to determine the impact of treating these conditions on patient outcomes and health care utilization.

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Associations of pain severity and mobility with age in chronic low back pain: does the type of assessment matter?

Innovation in Aging ◽

10.1093/geroni/igab046.3219 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 893-893

Author(s):

Taylor Buchanan ◽

Deanna Rumble ◽

Kristen Allen-Watts ◽

Katie O'Neal ◽

Tammie Quinn ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Chronic Low Back Pain ◽

Pain Severity ◽

Future Research ◽

Low Back ◽

Chi Square ◽

Clinical Pain ◽

Pain Symptoms

Abstract Chronic low back pain (cLBP) can lead to severe pain symptoms as well as disability in adults. As individuals age, pain symptoms and mobility outcomes can become increasingly debilitating. However, current findings regarding the influence of age on symptoms and outcomes are mixed and may be attributed to the assessment methodologies for pain and mobility. Therefore, we sought to examine the association of age with broad and specific assessments of pain severity and mobility commonly implemented in adults with cLBP. cLBP participants (n = 158) completed questionnaires regarding pain intensity and disability including demographics, Clinical Pain Assessment (CPA) and the Oswestry Low Back Pain questionnaire (OLBP). Participants also completed assessments of movement-evoked pain and difficulty by performing the Short Physical Performance Battery (SPPB). Pearson’s chi-square tests and regression-based analyses were conducted using SPSS version 26.0. Among cLBP participants, age was associated with pain-related disability indexed by section one of the OLBPS regarding pain intensity (F= 5.0, p<.05), and mobility via total SPPB score (F= 11.7, p<.05). Interestingly, age predicted greater self-reported difficulty climbing stairs (F= 21.7, p<.05), performing chores (F= 17.0, p<.05), walking (F= 14.0, p<.05), and running errands (F= 13.4, p<.05) from the CPA. Further, age predicted total balance (F= 3.2, p<.05), gait speed (F= 7.8, p<.05), and chair stand (F= 6.5, p<.05) scores of SPPB. Age is associated with questionnaires assessing cLBP pain severity and is also associated with mobility outcomes. Future research should seek to understand the influence of age on movement-evoked pain in cLBP.

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