Advertisement

Combined effects of lifestyle and psychosocial factors on central sensitization in patients with chronic low back pain: A cross-sectional study

Published:August 14, 2021DOI:https://doi.org/10.1016/j.jos.2021.07.012

      Abstract

      Background

      Central sensitization is one cause of chronic low back pain. Lifestyle and psychosocial factors are involved in the exacerbation of central sensitization. However, the combined effects of these factors on central sensitization in patients with chronic low back pain are unclear. The objective of this study was to investigate the combined effects of lifestyle and psychosocial factors on central sensitization in patients with chronic low back pain.

      Methods

      This was a cross-sectional study. The participants were recruited from three orthopedic clinics for a total of 70 patients with chronic low back pain. Data were analyzed using hierarchical multiple regression analysis. In Model 1, lifestyle factors such as sleep quality, physical activity, sitting time, and perceived stress were included. Model 2 included psychosocial factors (pain catastrophizing, anxiety, and depression).

      Results

      The data showed that sleep (b = 0.30) and perceived stress (b = 0.47) were significantly correlated in Model 1, and anxiety (b = 0.41) and perceived stress (b = 0.27) were significantly correlated in Model 2. Furthermore, contributions from sleep (b = 0.14) decreased, and no significant correlations were observed. The coefficient of determination increased significantly from Model 1 to Model 2 (ΔR 2 = 0.12, p < 0.05).

      Conclusions

      In this study, we clarified that perceived stress and anxiety were correlated with central sensitization in patients with chronic low back pain. In addition, sleep quality mediates anxiety and may be associated with central sensitization.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Orthopaedic Science
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Balagué F.
        • Mannion A.F.
        • Pellisé F.
        • Cedraschi C.
        Non-specific low back pain.
        Lancet. 2012; 379: 482-491
        • Correa J.B.
        • Costa L.O.
        • de Oliveira N.T.
        • Sluka K.A.
        • Liebano R.E.
        Central sensitization and changes in conditioned pain modulation in people with chronic nonspecific low back pain: a case-control study.
        Exp Brain Res. 2015 Aug; 233: 2391-2399
        • Loeser J.D.
        • Treede R.D.
        The kyoto protocol of IASP basic pain terminology.
        Pain. 2008 Jul 31; 137: 473-477
        • Sanzarello I.
        • Merlini L.
        • Rosa M.A.
        • Perrone M.
        • Frugiuele J.
        • Borghi R.
        • Faldini C.
        Central sensitization in chronic low back pain: a narrative review.
        J Back Musculoskelet Rehabil. 2016 Nov 21; 29: 625-633
        • Nijs J.
        • Loggia M.L.
        • Polli A.
        • Moens M.
        • Huysmans E.
        • Goudman L.
        • Meeus M.
        • Vanderweeen L.
        • Ickmans K.
        • Clauw D.
        Sleep disturbances and severe stress as glial activators: key targets for treating central sensitization in chronic pain patients?.
        Expert Opin Ther Targets. 2017 Aug; 21: 817-826
        • Park S.M.
        • Kim H.J.
        • Jeong H.
        • Kim H.
        • Chang B.S.
        • Lee C.K.
        • Yeom J.S.
        Longer sitting time and low physical activity are closely associated with chronic low back pain in population over 50 years of age: a cross-sectional study using the sixth Korea National Health and Nutrition Examination Survey.
        Spine J. 2018 Nov; 18: 2051-2058
        • Naugle K.M.
        • Riley 3rd, J.L.
        Self-reported physical activity predicts pain inhibitory and facilitatory function.
        Med Sci Sports Exerc. 2014 Mar; 46: 622-629
        • Agnew J.W.
        • Hammer S.B.
        • Roy A.L.
        • Rahmoune A.
        Central and peripheral pain sensitization during an ultra-marathon competition.
        Scand J Pain. 2018 Oct 25; 18: 703-709
        • Law L.F.
        • Sluka K.A.
        How does physical activity modulate pain?.
        Pain. 2017 Mar; 158: 369-370
        • Bushnell M.C.
        • Ceko M.
        • Low L.A.
        Cognitive and emotional control of pain and its disruption in chronic pain.
        Nat Rev Neurosci. 2013 Jul; 14: 502-511
        • Sjors A.
        • Larsson B.
        • Persson A.L.
        • Gerdle B.
        An increased response to experimental muscle pain is related to psychological status in women with chronic non-traumatic neck-shoulder pain.
        BMC Muscoskel Disord. 2011 Oct 12; 12: 230
        • Miki T.
        • Nishigami T.
        • Takebayashi T.
        • Yamauchi T.
        Association between central sensitivity syndrome and psychological factors in people with presurgical low back pain: a cross-sectional study.
        J Orthop Sci. 2021 July; 26: 337-342
        • Aoyagi K.
        • He J.
        • Nicol A.L.
        • Clauw D.J.
        • Kluding P.M.
        • Jernigan S.
        • Sharma N.K.
        A subgroup of chronic low back pain patients with central sensitization.
        Clin J Pain. 2019 Nov; 35: 869-879
        • Zhaoyang R.
        • Martire L.M.
        • Darnall B.D.
        Daily pain catastrophizing predicts less physical activity and more sedentary behavior in older adults with osteoarthritis.
        Pain. 2020 Nov; 161: 2603-2610
        • Zhang Y.
        • Peters A.
        • Chen G.
        Perceived stress mediates the associations between sleep quality and symptoms of anxiety and depression among college nursing students.
        Int J Nurs Educ Scholarsh. 2018 Jan 5; 15
        • Thabane L.
        Sample size determination in clinical trials McMaster university HRM-733 class Notes. 1. 2004: 1-42 (1)
        • Tanaka K.
        • Nishigami T.
        • Mibu A.
        • Manfuku M.
        • Yono S.
        • Shinohara Y.
        • Tanabe A.
        • Ono R.
        Validation of the Japanese version of the Central Sensitization Inventory in patients with musculoskeletal disorders.
        PLoS One. 2017; 12e0188719
        • Childs J.D.
        • Piva S.R.
        • Fritz J.M.
        Responsiveness of the numeric pain rating scale in patients with low back pain.
        Spine. 2005 Jun 1; 30: 1331-1334
        • Doi Y.
        • Minowa M.
        • Uchiyama M.
        • Okawa M.
        • Kim K.
        • Shibui K.
        • Kamei Y.
        Psychometric assessment of subjective sleep quality using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J) in psychiatric disordered and control subjects.
        Psychiatr Res. 2000; 97: 165-172
        • Murase N.
        • Ueda C.
        • Inoue S.
        • Shimomitsu T.
        Validity and reliability of Japanese version of international physical activity questionnaire.
        J Health and Welfare Stat. 2002; 49 ([In Japanese]): 1-9
        • Mimura C.
        • Griffiths P.
        A Japanese version of the Perceived Stress Scale: cross-cultural translation and equivalence assessment.
        BMC Psychiatr. 2008 Sep 30; 8: 85
        • Matsudaira T.
        • Igarashi H.
        • Kikuchi H.
        • Kano R.
        • Mitoma H.
        • Ohuchi K.
        • Kitamura T.
        Factor structure of the Hospital Anxiety and Depression Scale in Japanese psychiatric outpatient and student populations.
        Health Qual Life Outcome. 2009 May 17; 7: 42
        • Iwaki R.
        • Arimura T.
        • Jensen M.P.
        • Nakamura T.
        • Yamashiro K.
        • Makino S.
        • Obata T.
        • Sudo N.
        • Kubo C.
        • Hosoi M.
        Global catastrophizing vs catastrophizing subdomains: assessment and associations with patient functioning.
        Pain Med. 2012 May; 13: 677-687
        • Osteras B.
        • Sigmundsson H.
        • Haga M.
        Perceived stress and musculoskeletal pain are prevalent and significantly associated in adolescents: an epidemiological cross-sectional study.
        BMC Publ Health. 2015 Oct 23; 15: 1081
        • White R.S.
        • Jiang J.
        • Hall C.B.
        • Katz M.J.
        • Zimmerman M.E.
        • Sliwinski M.
        • Lipton R.B.
        Higher Perceived Stress Scale scores are associated with higher pain intensity and pain interference levels in older adults.
        J Am Geriatr Soc. 2014 Dec; 62: 2350-2356
        • Tsuboi Y.
        • Ueda Y.
        • Naruse F.
        • Ono R.
        The association between perceived stress and low back pain among eldercare workers in Japan.
        J Occup Environ Med. 2017 Aug; 59: 765-767
        • Clark J.R.
        • Nijs J.
        • Yeowell G.
        • Holmes P.
        • Goodwin P.C.
        Trait sensitivity, anxiety, and personality are predictive of central sensitization symptoms in patients with chronic low back pain.
        Pain Pract. 2019 Nov; 19: 800-810
        • Gould C.E.
        • Spira A.P.
        • Liou-Johnson V.
        • Cassidy-Eagle E.
        • Kawai M.
        • Mashal N.
        • O'Hara R.
        • Beaudreau S.A.
        Association of anxiety symptom clusters with sleep quality and daytime sleepiness.
        J Gerontol B Psychol Sci Soc Sci. 2018 Mar 2; 73: 413-420
        • Malfliet A.
        • Ickmans K.
        • Huysmans E.
        • Coppieters I.
        • Willaert W.
        • Bogaert W.V.
        • Rheel E.
        • Bilterys T.
        • Wilgen P.V.
        • Nijs J.
        Best evidence rehabilitation for chronic pain Part 3: low back pain.
        J Clin Med. 2019 Jul 19; 8
        • Wong J.J.
        • Cote P.
        • Sutton D.A.
        • Randhawa K.
        • Yu H.
        • Varatharajan S.
        • Goldgrub R.
        • Nordin M.
        • Gross D.P.
        • Shearer H.M.
        • Carroll L.J.
        • Stern P.J.
        • Ameis A.
        • Southerst D.
        • Mior S.
        • Stupar M.
        • Varatharajan T.
        • Taylor-Vaisey A.
        Clinical practice guidelines for the noninvasive management of low back pain: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.
        Eur J Pain. 2017 Feb; 21: 201-216