The Emotional Impact of Chronic Low Back Pain
with Michael Schatman, MD
Psychological stress in the form of emotional disturbance may lead acute low back pain to develop into a chronic pain condition, based on an analysis of 1,000 Japanese adults. Since the majority of chronic low back pain (CLBP) cases tend to be non-specific, Koichi Ouchi, MD, of Niigata University Medical and Dental Hospital in Japan, and colleagues, hypothesized that psychological factors, such as social stress, may be at play. “Emotional factors are undetectable by conventional medical checks, such as various imaging techniques,” they wrote in their paper. Therefore, they argued, CLBP patients may benefit from psychosocial treatment.1
To test their theory, Dr. Ouchi’s team developed a web-based survey to assess for psychogenic effects and physiological effects on chronic low back pain (CLBP) with the goal of guiding new treatment approaches. They recruited 1,000 patients from a Japanese survey database. The final study population (519 men and 481 women) was divided into two groups: 286 with CLBP and 714 with no CLBP. The average age of the participants was 40.5 years; the CLBP group included 153 men and 133 women.
Participants first completed the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), designed to assess five key domains of CLBP: low back pain, lumbar function, walking ability, social life function, and mental health. Scores range from 0 to 100, with lower scores reflecting a worse condition. Participants also filled out the team’s original online questionnaire which included questions across five categories: body, lifestyle, emotion, diet, and social life. Questions addressed activities such as age and body mass index in the body category; number of cigarettes smoked per day, sleep duration, and room temperature in the lifestyle category; and happiness, and anger in the emotion category. Two other factors assessed were: “outshout” (ie, frequency of shouting out loud in anger or frustration) and HIE, based on a traditional Chinese medicine concept defined as “feeling chilly.”
In their multivariate analysis, Dr. Ouchi’s team found that sleep, room temperature, outshout, and HIE were most associated with CLBP. They shared that “emotion was common to all the four extracted factors. There was no common physical divisor.”
PPM checked in with Michael Schatman, PhD, of Tufts School of Medicine in Boston, and editor-in-chief of the Journal of Pain Research, where Dr. Ouchi’s paper was published. “The authors are being appropriately cautious in their conclusions,” he said. Many psychological explanations may be given for back pain, although they are not necessarily scientific, he noted. “I applaud the authors for looking at both the physiological and psychological aspects of back pain. Rarely is it just one or the other.”
Dr. Schatman added that he was not surprised by most of the associations, including CLBP and the “outshout” category. “Angry people tend to hurt more,” based on principles of neuroplasticity, he explained. He added that he would like to see more research by the study authors or others to delve into the HIE concept to better understand its impact. “A review of the literature indicates that the concept of HIE has never been validated outside of Asian populations. Research validating the concept in non-Asian populations could potentially result in a better understanding as well as improved treatment of CLBP…. My suspicion is that HIE may related to anxiety, which can cause bio-constriction that might make the extremities cold,” he explained.
“The take-home message for clinicians is that both the physiological and psychological factors are important,” said Dr. Schatman. “The multimodal and holistic approach is worth considering, although insurance issues in the United States may be barriers to the multimodal and holistic approach the researchers recommend.”
