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A Controlled Examination of Medical and Psychosocial Factors Associated With Low Back Pain in Combination With Widespread Musculoskeletal Pain

M. Friedrich, MD, is Associate Professor and Head, Department of Orthopedic Pain Management, Orthopaedic Hospital Speising, Speisinger Strasse 109, Vienna 1130, Austria.
J. Hahne, MSc, is Scientific Staff Member, Center of Excellence for Orthopaedic Pain Management, Orthopaedic Hospital Speising.
F. Wepner, MD, is Resident in Orthopaedics, Center of Excellence for Orthopaedic Pain Management, Orthopaedic Hospital Speising.

katharina.gernesch{at}oss.at

Background: Little is known about chronic low back pain (CLBP) in combination with widespread musculoskeletal pain (WMP).

Objective: This study examined factors that may be common to these conditions, with the objective of detecting factors that could improve the course of these diseases.

Design: This was a prospective case control study.

Patients and Intervention: A group of patients with CLBP and WMP (CLBP+WMP group, n=97) was compared with a group of individuals who were pain-free and without a history of musculoskeletal problems (control group, n=97) and with a group of patients with CLBP but without WMP (CLBP-only group, n=52). The mean age of the participants was 42.9 years (SD=8.74); 76% were women, and 24% were men.

Measurements: A total of 74 variables were measured, including sociodemographic, physical, and psychosocial variables. After univariate examination for group differences and analyses of variables available for all 3 groups, logistic regression on selected factors was performed. The level was set at .05, but was adjusted to avoid randomly significant results.

Results: For a number of variables, significant differences among the 3 groups were observed. For regression model 1 for the CLBP+WMP and control groups, 4 out of 9 variables showed significant likelihood tests: income (lower in the WMP group), depression, anxiety, and fear-avoidance behavior. For regression model 2, 2 out of 13 variables showed significant likelihood tests: endurance capacity (more in the CLBP+WMP group) and balance capability (worse in the CLBP+WMP group). The models predicted at least 91.2% of all cases to the correct group. The regression analysis regarding the CLBP+WMP and CLBP-only groups predicted 86.7% of all cases to the correct group. Three out of 10 variables showed significant likelihood tests: high disability, fear-avoidance behavior, and number of treatments.

Limitations: Some variables in testing the patients with WMP and the individuals who were pain-free were not used with the patients with CLBP only.

Conclusions: Patients with CLBP and WMP should be examined for indicated physical and psychosocial factors. Therapeutic management should consider them in the early stage of the disease. These findings also might apply to patients with fibromyalgia or myofascial pain.

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