Factors accounting for psychosocial functioning in patients with low back pain

Low back pain (LBP) is a chronic disorder which exerts a profound impact on various spheres of psychosocial functioning, including emotional distress, functional limitations and decrements in social contacts. The objective of this study was to investigate the associations between the indices of psychosocial functioning in patients with chronic LBP and a range of psychological factors. Specifically, the study aimed at exploring the relative participation of personality, social support, disease-related cognitive appraisals and coping styles in accounting for the differences in psychosocial functioning of patients with LBP. One-hundred-twenty patients with LBP took part in the study and completed a battery of psychological questionnaires: NEO-Five Factors Inventory, Ways of Coping Questionnaire, Disease-Related Social Support Scale, Disease-Related Appraisals Scale and Psychosocial Functioning Questionnaire (PFQ). The PFQ dimensions were used as dependent variables in a series of stepwise regression analysis models with the scores from other questionnaires entered as independent variables. A cognitive appraisal of the disease in terms of an obstacle was strongly related to all domains of functioning; however, other appraisals (threat, challenge, harm, profit and overall disease importance) were uniquely associated with particular domains of functioning. Deprivation of social support was a significant predictor of distress experienced in interpersonal context and of sense of being disabled. Among basic personality traits, agreeableness was negatively associated with distress in interpersonal context, and conscientiousness was positively related to acceptance of life with the disease. Problem-focus coping was linked to higher acceptance of life with the disease. Among sociodemographic variables, older age and lower educational level were related to greater subjective feelings of being disabled. Pain severity was found unrelated to any of psychosocial functioning domains. Different aspects of psychosocial functioning are best accounted for by diverse patterns of psychological factors, which suggests involvement of different psychological mechanisms in development of LBP-related disability.