An accepting attitude and lack of negative cognition leads to less pain and disability related to chronic low back pain

Abstract

Introduction: Pain perception varies depending on the individual and influences treatment outcome. Psychological acceptance and wellbeing may affect pain perception and hence affects the rehabilitation of patients with chronic illnesses. This may have a profound impact on the functional capabilities of patients undergoing rehabilitation for chronic low back pain (LBP). Inclusion of psychological assessment and therapy in treating this group of patients may encourage improved self-perception and eventual return to normal social role. The aim of study is to determine the impact of psychological factors on pain perception and function, for potential application in rehabilitation. Methods: This was an assessment of a prospectively collected cohort of patients with chronic LBP enrolled in a 14-week rehabilitation programme comprising of intensive occupational therapy, physiotherapy and clinical psychology sessions. Assessments were conducted at baseline, 8-weeks and 14-weeks with questionnaires and interviews. An array of tests and inventories were used for functional and psychological assessment. Intensity of pain was assessed with Visual Analogue Scale (VAS), whereas patients’ self-perceived function and disability were evaluated with Oswestry Disability Index (ODI) and Spinal Function Sort Score (SFSS). For their psychological states, Bradburn Affect Balance Scale (BABS) was adopted to assess their general wellbeing, while Beck Depression Inventory (BDI) was used to specifically identify patients with inclination to depression. Acceptance of Illness Scale (AIS) was also used as a measure of patient response towards illness and its encompassing disability. Paired t-test and Wilcoxon signed rank tests were used to evaluate any statistically significant change before and after the programme. Spearman’s correlation test was used to correlate change in psychological parameters with that of physical and functional parameters. Results: A total of 191 patients (26.2% female) were recruited, with mean age of 40.2 years old (range 20-60 years). After the programme, ODI improved significantly (47.0 to 45.0, p<0.05), as with SFSS (98.3 to 108.1, p<0.05). Significant improvement was also observed in AIS (21.4 to 22.6, p<0.05) and BABS (0 to 4.3, p<0.05). However, patients reported increased BDI (17.0 to 19.5, p<0.05). An inverse correlation between change in AIS and change in VAS at rest (rs=-0.19, p<0.05) and under exertion (rs=-0.28, p<0.05) was observed. Conversely, change in BABS correlated positively with change in VAS at rest (rs=0.16, p=0.045) and under exertion (rs=0.23, p=0.004). Similarly, change in BDI was found to correlate positively with VAS at rest (rs=0.22, p<0.05) and under exertion (rs=0.20, p<0.05). Change in AIS correlated inversely with change in ODI (rs=-0.33, p<0.05). On the other hand, change in BDI positively correlated with change in ODI (rs=0.30, p<0.05). Discussion: Patients’ attitude towards chronic LBP influenced their self-perception of pain and function. Improved acceptance to their condition reduces their perceived pain. This may be related to development of an adaptive response to pain or modulating their perception of pain. Lack of negative cognitions also leads to less pain and disability. Improvements in key areas of depression, including anhedonia, loss of self-worth, hopelessness and guilt may prove to be important in rehabilitating this group of patients with chronic LBP.