ASSOCIATION OF CHRONIC LOW BACK PAIN AND DEPRESSION AT A TERTIARY CARE SETTING OF PAKISTAN

Main Article Content

Rabia Siddiqui
Saif Ullah Shaikh
Najmus Sahar
Muhammad Faisal Fahim

Abstract

Objective: To assess the association of Depression with Chronic Low back pain.


Methodology: In this cross-sectional investigation, 169 participants with a mean age of 54.1 years were studied at the PN Shifa medical outpatient department in Karachi, Pakistan. The research was conducted over a three-month period, from June to August 2020, using a non-probability convenience sampling approach. The severity of low back pain (LBP) was measured using the Numeric Rating Scale (NRS) and the Wong Baker Faces Pain Rating Scale. To evaluate levels of depression, the Patient Health Questionnaire (PHQ-9) scale was employed. The Chi-square test and one-way ANOVA test were used to establish statistical significance.


Results: Patients with moderate to severe chronic low back pain (CLBP) demonstrated higher pain levels on both the Wong Baker Faces Pain Rating Scale and NRS, with a p-value of 0.000. Based on the PHQ-9 scores, severe depression correlated with more intense pain, with a p-value of 0.000, and greater pain severity in the current and previous week (as assessed by the NRS and Wong Baker Faces Pain Rating Scale). A higher percentage of males (34%) experienced mild CLBP compared to females (22%). However, 26% of females were found to suffer from severe CLBP, as opposed to 12% of males, with a p-value of 0.014.


Conclusion: Patients with chronic low back pain often experience depression and report high levels of pain.

Article Details

How to Cite
1.
Rabia Siddiqui, Saif Ullah Shaikh, Najmus Sahar, Muhammad Faisal Fahim. ASSOCIATION OF CHRONIC LOW BACK PAIN AND DEPRESSION AT A TERTIARY CARE SETTING OF PAKISTAN. J Postgrad Med Inst [Internet]. 2023 May 22 [cited 2024 Mar. 28];37(2):140-5. Available from: https://jpmi.org.pk/index.php/jpmi/article/view/3197
Section
Original Article

References

Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010 Dec;24(6):769-81. DOI:10.1016/j. berh.2010.10.002.

Tsang SMH, Szeto GPY, Li LMK, Wong DCM, Yip MMP, Lee RYW. The effects of bending speed on the lumbo-pelvic kinematics and movement pattern during forward bending in people with and without low back pain. BMC Musculoskelet Disord. 2017;18(1):157. DOI:10.1186/s12891-017-1515-3.

3. Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743-800. DOI:10.1016/S0140-6736(15)60692- 4.

Wu A, March L, Zheng X, Huang J, Wang X, Zhao J, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020;8(6):299. DOI:10.21037/atm.2020.02.175.

Namgwa KJ, Terkura A, William Y, Daniel MD, Cornillus EL. Depression in patients with chronic low back pain: a hospital based study. Niger J Surg Res. 2016;17:1-4.

Solomou A, Kraniotis P, Rigopoulou A, Petsas T. Frequent Benign, Nontraumatic, Noninflammatory Causes of Low Back Pain in Adolescents: MRI Findings. Radiol Res Pract. 2018;2018:7638505. DOI:10.1155/2018/7638505.

Najafinejad S. Mindfulness intervention for chronic low back pain: A systematic review. Int J Musculoskelet Pain Prev. 2022;7(1):670–8. DOI:10.52547/ ijmpp.7.1.8.

Sakai Y, Matsui H, Ito S, Hida T, Ito K, Koshimizu H, et al. Sarcopenia in elderly patients with chronic low back pain. Osteoporos Sarcopenia. 2017;3(4):195– 200. DOI:10.1016/j.afos.2017.09.001.

Avila MJ, Walter CM, Baaj AA. Outcomes and Complications of Minimally Invasive Surgery of the Lumbar Spine in the Elderly. Cureus. 2016;8(3):e519. DOI:10.7759/cureus.519.

Shams T, Al Wadani H, El-Masry R, Zakaria O. Effect of prophylactic vitamin D on anesthetic outcome in children with sickle cell disease. J Anaesthesiol Clin Pharmacol. 2014;30(1):20-4. DOI:10.4103/0970-9185.125692.

Vietri J, Otsubo T, Montgomery W, Tsuji T, Harada E. The incremental burden of pain in patients with depression: results of a Japanese survey. BMC Psychiatry. 2015;15:104. DOI:10.1186/s12888- 015-0488-8.

Han C, Pae CU. Pain and depression: a neurobiological perspective of their relationship. Psychiatry Investig. 2015;12(1):1-8. DOI:10.4306/ pi.2015.12.1.1.

Denkinger MD, Lukas A, Nikolaus T, Peter R, Franke S; ActiFE study group. Multisite pain, pain frequency and pain severity are associated with depression in older adults: results from the ActiFE Ulm study. Age Ageing. 2014;43(4):510-4. DOI:10.1093/ageing/afu013.

Hiyama A, Watanabe M, Katoh H, Sato M, Sakai D, Mochida J. Effect of depression and neuropathic pain using questionnaires on quality of life in patients with low back pain; cross-sectional retrospective study. Eur Spine J. 2016;25(9):2750-60. DOI:10.1007/ s00586-016-4432-5.

Pinheiro MB, Ferreira ML, Refshauge K, Ordoñana JR, Machado GC, Prado LR, et al. Symptoms of Depression and Risk of New Episodes of Low Back Pain: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken). 2015;67(11):1591-603. DOI:10.1002/ acr.22619.

Matsudaira K, Kawaguchi M, Isomura T, Inuzuka K, Koga T, Miyoshi K, et al. Assessment of psychosocial risk factors for the development of non-specific chronic disabling low back pain in Japanese workers-findings from the Japan Epidemiological Research of Occupation-related Back Pain (JOB) study. Ind Health. 2015;53(4):368-77. DOI:10.2486/indhealth.2014-0260.

Hülsebusch J, Hasenbring MI, Rusu AC. Understanding Pain and Depression in Back Pain: the Role of Catastrophizing, Help-/Hopelessness, and Thought Suppression as Potential Mediators. Int J Behav Med. 2016;23(3):251-259. DOI:10.1007/s12529-015-9522-y.

Japanese Orthopaedic Association Clinical Practice Guidelines for the Management of Low Back Pain. Tokyo: Nankodo CoLtd. 2012.

Stefane T, Santos AM, Mavinovic A, Hortense P. Chronic Low back pain: Pain intensity, disability and quality of life. Acta Paul Enferm. 2013;26:14–20.

Frost H, Lamb SE, Doll HA, Carver PT, Stewart Brown S. Randomised controlled trial of physiotherapy compared with advice for low back pain. BMJ. 2004;329(7468):708. DOI: 10.1136/ bmj.38216.868808.7C.

Matsudaira K, Konishi H, Miyoshi K, Isomura T, Inuzuka K. Potential risk factors of persistent low back pain developing from mild low back pain in urban Japanese workers. PLoS One. 2014;9(4):e93924. DOI:10.1371/journal.pone.0093924. .

Nakamura M, Nishiwaki Y, Ushida T, Toyama Y. Prevalence and characteristics of chronic musculoskeletal pain in Japan. J Orthop Sci. 2011;16(4):424- 32. DOI:10.1007/s00776-011-0102-y.

Nakamura M, Toyama Y, Nishiwaki Y, Ushida T. Prevalence and characteristics of chronic musculoskeletal pain in Japan: a second survey of people with or without chronic pain. J Orthop Sci. 2014;19(2):339-350. DOI:10.1007/ s00776-013-0525-8.

Robertson D, Kumbhare D, Nolet P, Srbely J, Newton G. Associations between low back pain and depression and somatization in a Canadian emerging adult population. J Can Chiropr Assoc. 2017;61(2):96-105.

Pawlowska B, Tarczynska M, Gaweda K, Kukula B, Pic J, Szwarc B, et al. Symptoms of anxiety and depression in patients with chronic low back pain syndrome. Zdrow Publiczne [Internet]. 2013;123(2):148–52. DOI:10.12923/ j.0044-2011/123-2/a.10.

Park SM, Kim HJ, Jang S, Kim H, Chang BS, Lee CK, et al. Depression is Closely Associated With Chronic Low Back Pain in Patients Over 50 Years of Age: A Cross-sectional Study Using the Sixth Korea National Health and Nutrition Examination Survey (KNHANES VI-2). Spine (Phila Pa 1976). 2018;43(18):1281-8. DOI:10.1097/ BRS.0000000000002595.

Hung CI, Liu CY, Fu TS. Depression: An important factor associated with disability among patients with chronic low back pain. Int J Psychiatry Med. 2015;49(3):187-98. DOI:10.1177/0091217415573937.

Kakpovi K, Soedje KMA, Koffi Tessio VES, Ahoble KE, Fianyo E, Houzou P, et al. Anxiety and depression disorders in chronic non-specific low back pain in Lome (Togo). Open J Rheumatol Autoimmune Dis. 2017;07(01):1–15. DOI:10.4236/ojra.2017.71001.

Kopec JA, Sayre EC, Esdaile JM. Predictors of back pain in a general population cohort. Spine (Phila Pa 1976). 2004;29(1):70-7; discussion 77-8. DOI:10.1097/01. BRS.0000103942.81227.7F.

Uchmanowicz I, Koltuniuk A, Stepien A, Uchmanowicz B, Rosinczuk J. The influence of sleep disorders on the quality of life in patients with chronic low back pain. Scand J Caring Sci. 2019;33(1):119-27. DOI:10.1111/ scs.12610.

Smith BW, Zautra AJ, Parrish BP. Chronic pain: an integrated biobehavioral approach. Guilford Press; 2010.

Brosse AL, Sheets ES, Lett HS, Blumenthal JA. Exercise and the treatment of clinical depression in adults: recent findings and future directions. Sports Med. 2002;32(12):741-60. DOI:10.2165/00007256-200232120- 00001.

Kang JM. Korean version of pain-related self-report questionnaires. Korean J Anesthesiol. 2014;66(6):415-6. DOI:10.4097/kjae.2014.66.6.415.

Steffen A, Nübel J, Jacobi F, Bätzing J, Holstiege J. Mental and somatic comorbidity of depression: a comprehensive cross-sectional analysis of 202 diagnosis groups using German nationwide ambulatory claims data. BMC Psychiatry. 2020;20(1):142. DOI:10.1186/ s12888-020-02546-8.

Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736-47. DOI:10.1016/S0140-6736(16)30970- 9.

Shiri R, Falah Hassani K, Heliovaara M, Solovieva S, Amiri S, Lallukka T, et al. Risk Factors for Low Back Pain: A Population-Based Longitudinal Study. Arthritis Care Res (Hoboken). 2019;71(2):290-9. DOI:10.1002/ acr.23710.

Namgwa KJ, Terkura A, William Y, Daniel MD. Depression in patients with chronic low back pain. A hospital-based study. Niger J Surg Res. 2016;17(1):1–4.

Sribastav SS, Peiheng H, Jun L, Zemin L, Fuxin W, Jianru W, et al. Interplay among pain intensity, sleep disturbance and emotion in patients with non-specific low back pain. PeerJ. 2017;5:e3282. DOI:10.7717/peerj.3282.