Functional disability in patients with low back pain: the mediator role of suffering and beliefs about pain control in patients receiving physical and chiropractic treatment.
M Graça Pereira, Edite Roios, Marta Pereira
PMID 28716365WHAT IT FOUND
In chronic back pain patients, subjective suffering mediated the link between depression and disability in both physical and chiropractic groups.
Believing pain is controlled by chance events mediated this link only in the physical therapy group. Anxiety did not act through these mediators.
Key findings
01Subjective suffering mediated the relationship between depression and functional disability in both the chiropractic and physical therapy groups.
02Beliefs that pain is controlled by chance events mediated the relationship between depression and functional disability only in the physical therapy group.
03Anxiety did not show a mediated effect on functional disability through suffering or pain control beliefs in either treatment group.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The cross-sectional design prevents establishing causality; we cannot know if suffering causes disability or vice versa. Data relied entirely on self-report questionnaires, which are subject to recall and response bias. The sample was a convenience sample, and chiropractic patients were recruited only from private clinics, which may limit generalizability. The study did not control for medication use, which may have influenced pain perception and psychological variables, particularly in the physical therapy group where patients were often referred by physicians.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not assume that treating suffering or changing pain beliefs will reduce disability. This study shows an association in a cross-sectional snapshot, not that these factors cause disability or that interventions targeting them will improve outcomes. Longitudinal and experimental studies are needed to test this.