Quality of Life and Mental Distress in Patients with Chronic Low Back Pain: A Cross-Sectional Study

The impact of emotional distress on response to radiofrequency ablation

Introduction

Radiofrequency ablation (RFA) is commonly performed for facet-mediated cervical, thoracic, and lumbar spine pain. Inadequate relief from RFA may be because of biopsychosocial factors not addressed with RFA.

Objectives

To investigate the effects of baseline emotional distress on RFA treatment response.

Methods

Patients who completed self-reported surveys, Patient-Reported Outcomes Measurement System (PROMIS), from January 2021 through July 2023 were included. Additional baseline information was obtained by retrospective review. The primary outcome was PROMIS Pain Intensity T-scores at 6 weeks, 3 months, and 6 months after RFA. The main predictor of interest was emotional distress, computed as average baseline PROMIS T-scores for depression and anxiety. Interaction terms tested how the influence of baseline emotional distress and pain intensity changed over the follow-up period.

Results

Data were available for 154, 101, 91, and 83 participants at baseline, 6 weeks, 3 months, and 6 months post-RFA, respectively. Baseline emotional distress (P = 0.04) and baseline pain intensity (P = 0.01) were both associated with worse pain intensity at follow-up, controlling for each other. Interaction terms were not significant, though visual inspection of trends suggested that the influence of baseline emotional distress may increase as the follow-up period lengthens.

Conclusion

Patients reporting higher levels of baseline emotional distress experience less pain reduction after RFA, controlling for baseline pain intensity. Patients with greater emotional distress may benefit from treatments addressing emotional distress, in addition to or instead of RFA.

Integrating multidimensional data analytics for precision diagnosis of chronic low back pain

Low back pain (LBP) is a leading cause of disability worldwide, with up to 25% of cases become chronic (cLBP). Whilst multi-factorial, the relative importance of contributors to cLBP remains unclear. We leveraged a comprehensive multi-dimensional data-set and machine learning-based variable importance selection to identify the most effective modalities for differentiating whether a person has cLBP. The dataset included questionnaire data, clinical and functional assessments, and spino-pelvic magnetic resonance imaging (MRI), encompassing a total of 144 parameters from 1,161 adults with (n = 512) and without cLBP (n = 649). Boruta and random forest were utilised for variable importance selection and cLBP classification respectively. A multimodal model including questionnaire, clinical, and MRI data was the most effective in differentiating people with and without cLBP. From this, the most robust variables (n = 9) were psychosocial factors, neck and hip mobility, as well as lower lumbar disc herniation and degeneration. This finding persisted in an unseen holdout dataset. Beyond demonstrating the importance of a multi-dimensional approach to cLBP, our findings will guide the development of targeted diagnostics and personalized treatment strategies for cLBP patients.

Chronic low back pain and postural instability: interaction effects of pain severity, age, BMI, and disability

Objectives

This study aimed to (1) compare postural sway patterns between individuals with chronic low back pain (CLBP) and asymptomatic controls, (2) evaluate correlations between pain severity and postural stability variables, and (3) assess the interaction effects of age, BMI, pain severity, and disability on postural stability under eyes-open and eyes-closed conditions.

Methods

Postural stability (sway area, sway velocity, CoP displacement) was assessed in 88 CLBP patients and 88 controls using a stabilometric platform. Pain severity (VAS) and disability (ODI) were recorded alongside demographic data. Statistical analyses included t-tests, Pearson's correlations, and ANOVA to explore group differences, correlations, and interaction effects.

Results

Chronic low back pain patients exhibited significantly greater postural sway across all conditions, with larger sway area (16.80 ± 6.10 cm2 vs. 11.50 ± 4.10 cm2, p = 0.004) and higher sway velocity (4.10 ± 1.40 cm/s vs. 2.90 ± 1.00 cm/s, p = 0.009) under eyes-closed conditions. Pain severity correlated with sway velocity (r = 0.52, p = 0.003) and CoP displacement (r = 0.57, p = 0.002). Interaction effects indicated greater instability in older, obese individuals with severe pain and high disability.

Conclusion

Chronic low back pain is associated with impaired postural stability, influenced by pain severity, BMI, age, and disability. Targeted interventions addressing these factors are essential for improving balance and reducing fall risk.

Relationship Between Psychological Factors and Health-Related Quality of Life in Patients with Chronic Low Back Pain

BACKGROUND

Low back pain has frequently been mentioned as the most common sort of chronic pain, and numerous studies have confirmed its influence on the health-related quality of life (HRQoL). Despite a great deal of research demonstrating the important part that psychological factors play in explaining HRQoL, a therapeutic setting that prioritizes the physical domain still predominates. For this reason, the aim of this study is to assess the relationship between age, pain intensity, pain catastrophizing, depression, anxiety, pain-related anxiety, chronic pain acceptance and the psychological and physical dimensions of HRQoL in patients with chronic low back pain (CLBP).

METHODS

Data were collected from 201 patients with CLBP using sociodemographic data, the SF-36 Health Status Questionnaire (SF-36), the Hospital Anxiety and Depression Scale (HADS), the Pain Anxiety Symptoms Scale Short Form 20 (PASS-20), the Pain Catastrophizing Scale (PCS), the Chronic Pain Acceptance Questionnaire (CPAQ-8) and the Numeric Pain Rating Scale (NRS). The linear regression model for the dependent variable of Physical Health (SF-36 PhyH) was statistically significant (F (7, 201) = 38.951, p < 0.05), explaining 57.6% of the variance regarding the Physical Health dimension of HRQL in patients with CLBP.

RESULTS

The linear regression model for the dependent variable of Psychological Health (SF-36 PsyH) was statistically significant (F (7, 200) = 39.049, p < 0.05), explaining 57.7% of the variance regarding the Psychological Health dimension of HRQL in patients with CLBP.

CONCLUSIONS

The findings of this study confirm that age, pain intensity, depression, pain-related anxiety and chronic pain acceptance are significant predictors of the physical dimension of HRQoL, while pain intensity, anxiety and depression proved to be significant predictors of the psychological dimension of HRQoL in patients with CLBP.

Duloxetine for individuals with chronic back pain: A systematic review and meta‑analysis of randomized controlled trials

The current study aimed to assess the efficacy of duloxetine in reducing pain and improving the quality of life of individuals with chronic low back pain (CLBP). An extensive literature search was conducted to identify relevant studies that examined the efficacy of duloxetine in CLBP management. The primary objective of the present study was to assess the role of duloxetine use on pain levels, as well as improvements in quality of life, using validated instruments. The results were synthesized using a random-effects model. A total of 8 studies were included in the analysis. Duloxetine demonstrated clear benefits in pain reduction, evidenced by improvements across multiple scales including the visual analogue scale, brief pain inventory-interference (BPI), BPI-severity, weekly worst pain over 24 hours and Roland-Morris Disability Questionnaire scores. Quality of life improved with duloxetine treatment, as indicated by the 36-item short form survey (SF-36). However, there was no significant impact on the physical function component of SF-36. The present study provides evidence to affirm the efficacy of duloxetine in treating CLBP. Further research is required to validate these findings and to establish whether combining duloxetine with other CLBP treatments yields superior outcomes.

A Systematic Review on the Neuropsychological Assessment of Patients with LBP: The Impact of Chronic Pain on Quality of Life

Background and objective: Low back pain (LBP) is most common pain syndrome in Europe, affecting approximately 50% of European citizens. LBP is a complex condition that negatively affects many aspects of an individual's life such as work productivity, mobility, and mental health. The aim of this study is to assess the impact of pain associated with chronic LBP on patients' quality of life. Methods: Clinical studies reviewed in our search with no time restrictions were identified from PubMed, Web of Science, Scopus, and Cochrane Library databases. Of the initial 1929 studies, only 15 met inclusion criteria. Results: Results of our study indicate that chronic pain has a negative impact on numerous functions and areas in which the individual is involved and that this condition leads to reduced performance. Conclusions: LBP is a debilitating condition for patients, negatively affecting quality of life. Future studies should focus on validating a standardized assessment that examines all aspects affected by LBP through a customized questionnaire.

Quality of Life, Disability Level, and Pain Intensity among Patients after Lumbar Disc Surgery: An Observational Three-Month Follow-Up Study

The prevalence of intervertebral disc degeneration in the lumbar region resulting in low back pain is high. One of the treatment options is neurosurgery. Previous studies and systematic reviews demonstrate the need to identify factors that affect the health-related quality of life of patients undergoing surgery. This study aimed to analyze the sociodemographic and clinical factors that affect the quality of life of patients undergoing lumbar disc surgery. A group of 128 patients was assessed for eligibility and qualified by radiological examinations for lumbar disc surgery by a neurosurgeon in the outpatient clinic. Finally, 110 patients were studied and evaluated 24 h and 3 months after surgery. Health-related quality of life (36-Item Short Form Survey, SF-36), disability level (Oswestry Disability Index, ODI), and pain intensity (Visual Analogue Scale, VAS) were assessed. The mean pain intensity before surgery was 7.8 ± 2.3 pts and decreased significantly 24 h after surgery, with a mean score of 3.8 ± 2.4 pts (p = 0.0000). After three months, the increase in pain intensity was at 4.8 ± 2.4 pts, but the score was still significantly better than before surgery (p = 0.0024). The mean ODI score before surgery was 29.3 ± 8.4 pts (slight disability), and three months after surgery, there was an insignificant increase to a mean value of 31.5 ± 10.4 pts (p = 0.0834). There was a statistically significant increase in quality-of-life scores at three months after surgery in the following domains: physical functioning (8.7%; p = 0.0176), bodily pain (26.2%; p = 0.0000), vitality (5.8%; p = 0.0132) and mental health (6.2%; p = 0.0163), and a decrease in role limitations due to physical problems (3.8; p = 0.0013) and general health perception (6.7%; p = 0.0112). In conclusion, the surgical procedure plays an important role in improving the quality of life of patients operated on for intervertebral disc degeneration. It was effective in reducing the pain level, especially 24 h after surgery; however, surgery did not affect the disability level.

Exploring the bidirectional relationship between pain and mental disorders: a comprehensive Mendelian randomization study

BACKGROUND

The close relationship between pain and mental health problems is well-known, and psychological intervention can provide an effective alternative to medication-based pain relief. However, previous studies on the connection between pain and psychological problems, the findings thus far have been inconclusive, limiting the potential for translating psychological interventions into clinical practice. To complement the gap, this study utilized genetic data and Mendelian randomization (MR) to examine the potential relationship between pain in different parts and common mental disorders.

METHODS

Based on the instrumental variables selected from the Genome-wide association study summary statistics of localized pain and mental disorders, we conducted bidirectional two-sample MR analyses to infer bidirectional causal associations between pain and mental disorders. The inverse-variance weighted MR method and MR-Egger were used as the primary statistical method according to the horizontal pleiotropy and heterogeneity level. We reported the odds ratio to infer the causal effect between pain and mental disorders. F statistic was calculated to measure the statistical efficacy of the analyses.

RESULTS

Insomnia is causally related to the genetic susceptibility of multisite pain including head (OR = 1.09, 95% CI: 1.06-1.12), neck/shoulder (OR = 1.12, 95% CI: 1.07-1.16), back (OR = 1.12, 95% CI: 1.07-1.18) and hip (OR = 1.08, 95% CI: 1.05-1.10). Reversely, headache (OR = 1.14, 95% CI: 1.05-1.24), neck/shoulder pain (OR = 1.95, 95% CI: 1.03-3.68), back pain (OR = 1.40, 95% CI: 1.22-1.60), and hip pain (OR = 2.29, 95% CI: 1.18-4.45) promote the genetic liability of insomnia. Depression is strongly associated with the predisposition of multisite pain including headache (OR = 1.28, 95% CI: 1.08-1.52), neck/shoulder pain (OR = 1.32, 95% CI: 1.16-1.50), back pain (OR = 1.35, 95% CI: 1.10-1.66) and stomach/abdominal pain (OR = 1.14, 95% CI: 1.05-1.25), while headache (OR = 1.06, 95% CI: 1.03-1.08), neck/shoulder (OR = 1.09, 95% CI: 1.01-1.17), back (OR = 1.08, 95% CI: 1.03-1.14), and stomach/abdominal pain (OR = 1.19, 95% CI: 1.11-1.26) are predisposing factors for depression. Additionally, insomnia is associated with the predisposition of facial, stomach/abdominal, and knee pain, anxiety was associated with the predisposition of neck/shoulder and back pain, while the susceptibilities of hip and facial pain are influenced by depression, but these associations were unidirectional.

CONCLUSIONS

Our results enhance the understanding of the complex interplay between pain and mental health and highlight the importance of a holistic approach to pain management that addresses both physical and psychological factors.

Effectiveness of Epidural Steroid Injection Depending on Discoradicular Contact: A Prospective Randomized Trial

Lumbar radicular pain is a major public health and economic problem. It is among the most common reasons for professional disability. The most common cause of lumbar radicular pain is intervertebral disc herniation, which results from degenerative disc changes. The dominant pain mechanisms are direct pressure of the hernia on the nerve root and the local inflammatory process triggered by intervertebral disc herniation. Treatment of lumbar radicular pain includes conservative, minimally invasive, and surgical treatment. The number of minimally invasive procedures is constantly increasing, and among these methods is epidural administration of steroids and local anesthetic through a transforaminal approach (ESI TF). The aim of this research was to examine the effectiveness of ESI TF as measured by a visual analog scale (VAS) and the Oswestry Disability Index (ODI), depending on whether there is contact between the herniated intervertebral disc and the nerve root. In both groups of participants, there was a significant reduction in pain intensity, but there was no significant difference between the groups. In the group with disc herniation and nerve root contact, the only significant reduction was in pain intensity (p < 0.001). There were no significant differences in measurements in other domains of the ODI. In the group without disc herniation and nerve contact, there was a significant difference in all domains except weight lifting. In the group without contact, there was significant improvement after 1 month (p = 0.001) and 3 months (p < 0.001) according to the ODI, while there was no significant improvement in the group with contact. In addition, there were no significant differences in the distribution of participants based on the ODI and whether disc herniation and nerve contact was present. The results suggest that transforaminal epidural administration of steroids is a clinically effective method for treating lumbar radicular pain caused by intervertebral disc herniation in people with and without nerve root contact, without significant differences.

Influence of the Cognitive and Emotional Status of Patients with Chronic Pain on Treatment Success (Reduction in Pain Intensity and Adherence to Pharmacotherapy): A Prospective Study

This prospective study aimed to determine the cognitive and emotional status among patients with chronic pain and to examine the potential influence on the treatment success, measured by the reduction in pain intensity and adherence to pharmacotherapy. A total of seventy patients were followed for two months. The results of the comparison between patients who did and did not follow the physician’s instructions regarding adherence to pharmacotherapy showed a significant difference in cognitive status and a reduction in pain intensity. Patients who followed the physician’s instructions on taking analgesics had significantly higher scores on the Montreal Cognitive Assessment (MoCA) of cognitive status and a substantially higher reduction in pain intensity. Scores on the MoCA test provide statistically significant indications regarding patients’ decision to follow instructions regarding adherence to pharmacotherapy. Scores on the MoCA test, anxiety, age, and pain intensity (measured with a numeric rating scale—NRS) on admission were identified as potential predictors for the reduction in pain intensity. The linear regression model was statistically significant (χ2 = 40.0, p < 0.001), explained between 43.5% and 61.1% of variance regarding the reduction in pain intensity. The findings of this study show that cognitive status, measured with MoCA, and emotional status, measured with the Depression, Anxiety, and Stress Scale (DASS-21), significantly influence the reduction in pain intensity and adherence to pharmacotherapy. The results suggest that cognitive and emotional status may be potential predictors of treatment success. This finding points to the importance of a biopsychosocial approach in the treatment of chronic pain, where an important emphasis can be placed on the psychosocial determinants of pain.

Recent and Frequent Mental Distress Among Women with a History of Military Service, 2003–2019

Examining women veterans' self-reported mental health is critical to understanding their unique mental and physical health needs. This study describes self-reported mental distress over a 17-year period among cross-sectional nationally representative samples of women in the USA using data from the Behavioral Risk Factor Surveillance System (BRFSS) core national surveys from 2003 to 2019. Nationally representative prevalence estimates of self-reported mental distress were compared between women veterans and their (1) men veteran and (2) women civilian counterparts. In each year examined, women veterans report significantly more days of recent mental distress and significantly higher prevalence of frequent mental distress than their men veteran counterparts. In several years, women veterans also report greater levels of recent and frequent mental distress than women civilians. These findings highlight the long-standing high prevalence of self-reported poor mental health among women veterans and suggest that specific efforts to address mental health among women veterans as a unique population may be warranted.