Investigating key predictors of persistent low back pain: A focus on psychological stress.
Katherine M Bernier Carney, Jessica W Guite, Erin E Young and 1 others
PMID 33745554WHAT IT FOUND
In acute low back pain, higher stress, worse pain, and lower pressure thresholds were linked to less pain resolution.
In the final model, household income greater than $60,000 per year was the strongest predictor.
Key findings
01Participants with perceived stress scores greater than 17 were 44.5% less likely to experience pain resolution (HR 0.555, 95% CI 0.36-0.85, p=0.02).
02Household income was the dominant predictor in the final model, with hazard ratio 2.79 (95% CI 1.63-4.67, p < 0.001).
03Higher pressure pain thresholds at the painful low back site (HR 1.885, 95% CI 1.14-3.11, p=0.01) and control site (HR 2.159, 95% CI 1.31-3.35, p=0.001) were associated with greater likelihood of pain resolution.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for RNs
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What it does not show
More than 30% of participants did not complete follow-up, leaving 83 pain trajectories undefined, and censoring methods may not have removed bias. The final model included only variables significant in bivariate analyses, so sex and body mass index were not included despite prior reports that they affect persistent low back pain outcomes. Perceived stress was measured only at baseline, so the study cannot show whether stress changes as pain continues or whether stress explains ongoing pain. No intervention was tested, so the paper cannot show that changing stress, pain or household income alters pain resolution.
Declared interests
The authors declare no conflicts of interest. The article is indexed as supported by NIH extramural research.
The easy way to misread this
Do not conclude that reducing stress will prevent persistent low back pain. The study measured associations at baseline, did not test a stress intervention, and household income was the strongest predictor.