How mood disorders affect chronic low back pain
Patients with anxiety and depression may be less satisfied than other patients with their chronic low back pain treatments, new research suggests.
"Patients with anxiety/depression symptoms experienced more pain severity and more pain-related functional, social and emotional disability, and they were less satisfied with care, compared with the other groups," the authors write in the journal Pain Management.
The researchers from the University of Porto in Portugal examined baseline and one-year follow-up data collected by four pain clinics.
The 284 adult patients with chronic low back pain with radiculopathy had an average age of 60.
Patients with cancer pain, psychiatric or cognitive disorders that might affect data collection, and those unable to communicate in Portuguese, were excluded.
At the beginning of the study, patients gave details of their sociodemographics, medical comorbidities and pain coping strategies, and the researchers extracted data from the clinical chart.
They were interviewed again by telephone one year later.
Their anxiety and depression symptoms were evaluated using the Hospital Anxiety and Depression Scale, and outcomes were assessed using the Brief Pain Inventory and the Shortened Treatment Outcomes in Pain Survey (S-TOPS).
The authors used linear mixed effects models to assess the impact of anxiety and depression and their interactions on treatment outcomes.
At one year, the 146 patients with both anxiety and depression experienced higher pain severity and interference compared with the 61 patients with anxiety only, the 19 with depression only, or the 58 with no symptoms.
In the S-TOPS, their pain-related upper-body disability was significantly higher, and their satisfaction with care and with outcomes was significantly lower.
"From my clinical experience, patients with chronic lower back pain reach a degree of hopelessness when their pain is not addressed despite multiple therapies," according to Michigan State University's Dr Lisa DeStefano, who was not involved in the study.
"Often it causes them to seek more and more care and therapies out of desperation. This makes them feel vulnerable and desperate and feeds their hopelessness."
The authors recommend more individualised intensive chronic pain management for these patients, possibly before or along with other interventions.