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Beliefs about the causes and consequences of pain in patients with chronic inflammatory or noninflammatory low back pain and in pain-free individuals.

Sloan TJ, Gupta R, Zhang W, Walsh DA

Academic Rheumatology, University of Nottingham Clinical Sciences Building, Nottingham, UK.

STUDY DESIGN: Case control study including 2 groups of patients with low back pain (LBP, inflammatory and noninflammatory) and a pain-free community control group. OBJECTIVE: We explored whether pain beliefs differ between patients with chronic LBP attributed to inflammatory or noninflammatory medical diagnoses, and between patients with chronic LBP and pain-free controls. SUMMARY OF BACKGROUND DATA: Beliefs strongly influence patients' engagement in and response to treatments for chronic LBP. It is unclear, however, whether unhelpful beliefs held by patients with chronic LBP are predominantly associated with diagnosis, or with other aspects of the patient's pain experience. METHODS: Patients and controls completed the pain beliefs questionnaire addressing beliefs about the causes and consequences of pain. Patients also completed questionnaires addressing catastrophizing (Coping Strategies Questionnaire), physical disability and bodily pain (SF-36 Health Survey), and psychological distress (Spielberger State-Trait Anxiety Inventory Short Form and Cognitive Depression Index). Variance analysis and chi2 test were used as appropriate, adjusting for effects of covariates and multiple comparisons. Linear regression and logistic regression were used to adjust for confounding factors. RESULTS: Patients with noninflammatory LBP more strongly endorsed organic pain beliefs (e.g., that pain necessarily indicates damage), and catastrophizing (e.g., that the pain is never going to get better), than did patients with inflammatory LBP (P < 0.01). Patients with inflammatory LBP, in turn, more strongly endorsed organic pain beliefs than did pain-free controls (P < 0.05). Endorsement of organic pain beliefs was associated with catastrophizing. CONCLUSION: Organic pain beliefs are associated with increased catastrophizing in patients with chronic LBP, and addressing these beliefs may help patients to manage their pain and disability. Meanings attributed to inflammatory and noninflammatory diagnostic labels may contribute to the different pain beliefs held by different patient groups.

Published 22 April 2008 in Spine, 33(9): 966-72.
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