Emotional Distress, Pain Catastrophizing and Expectancies in Patients with Low Back Pain

Abstract Low back pain (LBP) is an important aspect of vertebral pathology. Due to its medical, social and financial importance, acute and chronic LBP is an important concern of the medical world. Pain catastrophizing and response expectancies are among the most robust psychological predictors of pain outcomes. Pain experience has been studied in relationship with pain catastrophizing on one hand, and in relationship with emotional distress, and with response expectancies on the other hand. Fewer studies have looked at relationships with hope. The current study was designed to investigate all these variables in one research. We assessed 46 patients (aged 27 to 84, 17 men and 29 women) with LBP to see the relevance of and relations between pain catastrophizing (Pain Catastrophizing Scale), emotional distress (Hospital Anxiety and Depression Scale), pain outcomes (SF-McGill Pain Questionnaire) and expectancies and hopes for pain relief after treatment. Our results show that pain catastrophizing totally mediates the relationship between pain and emotional distress and is related to expectancies. Chronic pain patients have more negative expectancies and hopes for pain relief after treatment as compared to acute pain patients. Implications for research and treatment are discussed. Keywords: low back pain, pain catastophizing, emotional distress, secondary prevention Low back-pain (LBP) is an important aspect of vertebral pathology, accounting for approximately 12-30% of European population morbidity; according to recent studies, its prevalence could be as high as 60-80% among the adult population in the United States and Europe (DeLisa, 2005). Also, it has been established that LBP is the second most frequent cause of disability in the adult population (over 45 years of age) in Europe, and the third cause in the United States. In the US, annual costs required by investigations, treatment, and decreased job performance raise up to the impressive amount of 50 billion dollars (DeLisa, 2005). About 80-90% of the money spent on patients suffering from LBP is accounted for by the treatment costs of the 10% that develop chronic LBP. Clinical Guidelines concerning the management of LBP recommend, besides conservative medication therapy, physiokinetotherapy for patients with unfavorable evolution, and cognitive-behavioral therapy for those with sub-acute and chronic pain (Barclay, 2007). Acute pain plays an important role in signaling potential injury or damage to muscles, tissue or nerves. Chronic pain however, serves no immediate purpose (Winterowd, Beck, & Gruener, 2003), and it poses a significantly greater psychological strain on the patient and is perhaps one of the most challenging problems faced by healthcare consumers as well as health care practitioners and providers. It is a problem of enormous magnitude in society, yet there is overwhelming evidence that it is inadequately treated (for details see Winterowd Beck, & Gruener, 2003). There are two important psychological factors that have proved to be of predictive value in pain outcomes research: pain catastrophizing and response expectancies. Catastrophizing is defined as "an exaggerated negative mental set brought to bear during actual or anticipated painful experience" (Sullivan et al., 2001). Pain catastrophizing is a multidimensional construct comprising elements of rumination ("I can't stop thinking about how much it hurts"), magnification ("I worry that something serious may happen"), and helplessness ("There is nothing I can do to reduce the intensity of the pain"). There is an abundance of data in the field of pain indicating that catastrophizing plays an important role in producing pain related outcomes (e.g., pain intensity, pain related disability) in both healthy (e.g., France et al, 2002., Seminowicz & Davis, 2006) or clinical populations (e.g., Peters, Vlayen, & Weber, 2005; Sullivan, Lynch, & Clarck, 2005; Pavlin, Sullivan, Freund, & Roesen, 2005). …