Puschmann Anne-Katrin, Drießlein David, Beck Heidrun, Arampatzis Adamantios, Moreno Catalá Maria, Schiltenwolf Marcus, Mayer Frank, Wippert Pia-Maria
Sociology of Health and Physical Activity, University of Potsdam, Potsdam, Germany.
Statistical Consulting Unit, Ludwig-Maximilians-University Munich, Munich, Germany.
J Pain Res. 2020 Mar 24;13:613-621. doi: 10.2147/JPR.S223893. eCollection 2020.
Psychosocial variables are known risk factors for the development and chronification of low back pain (LBP). Psychosocial stress is one of these risk factors. Therefore, this study aims to identify the most important types of stress predicting LBP. Self-efficacy was included as a potential protective factor related to both, stress and pain.
This prospective observational study assessed n = 1071 subjects with low back pain over 2 years. Psychosocial stress was evaluated in a broad manner using instruments assessing perceived stress, stress experiences in work and social contexts, vital exhaustion and life-event stress. Further, self-efficacy and pain (characteristic pain intensity and disability) were assessed. Using least absolute shrinkage selection operator regression, important predictors of characteristic pain intensity and pain-related disability at 1-year and 2-years follow-up were analyzed.
The final sample for the statistic procedure consisted of 588 subjects (age: 39.2 (±13.4) years; baseline pain intensity: 27.8 (±18.4); disability: 14.3 (±17.9)). In the 1-year follow-up, the stress types "tendency to worry", "social isolation", "work discontent" as well as vital exhaustion and negative life events were identified as risk factors for both pain intensity and pain-related disability. Within the 2-years follow-up, Lasso models identified the stress types "tendency to worry", "social isolation", "social conflicts", and "perceived long-term stress" as potential risk factors for both pain intensity and disability. Furthermore, "self-efficacy" ("internality", "self-concept") and "social externality" play a role in reducing pain-related disability.
Stress experiences in social and work-related contexts were identified as important risk factors for LBP 1 or 2 years in the future, even in subjects with low initial pain levels. Self-efficacy turned out to be a protective factor for pain development, especially in the long-term follow-up. Results suggest a differentiation of stress types in addressing psychosocial factors in research, prevention and therapy approaches.
社会心理变量是已知的下腰痛（LBP）发生和慢性化的危险因素。心理社会应激是这些危险因素之一。因此，本研究旨在确定预测LBP的最重要的应激类型。自我效能感被纳入作为与应激和疼痛相关的潜在保护因素。
这项前瞻性观察性研究对1071名患有下腰痛的受试者进行了为期2年的评估。使用评估感知应激、工作和社会环境中的应激经历、倦怠和生活事件应激的工具，广泛评估心理社会应激。此外，还评估了自我效能感和疼痛（特征性疼痛强度和残疾程度）。使用最小绝对收缩选择算子回归分析了1年和2年随访时特征性疼痛强度和疼痛相关残疾的重要预测因素。
统计程序的最终样本包括588名受试者（年龄：39.2（±13.4）岁；基线疼痛强度：27.8（±18.4）；残疾程度：14.3（±17.9））。在1年随访中，“担忧倾向”“社会隔离”“工作不满”以及倦怠和负面生活事件等应激类型被确定为疼痛强度和疼痛相关残疾的危险因素。在2年随访中，套索模型确定“担忧倾向”“社会隔离”“社会冲突”和“感知长期应激”等应激类型是疼痛强度和残疾程度的潜在危险因素。此外，“自我效能感”（“内控性”“自我概念”）和“社会外控性”在减轻疼痛相关残疾方面发挥作用。
社会和工作相关环境中的应激经历被确定为未来1年或2年LBP的重要危险因素，即使是初始疼痛水平较低的受试者。自我效能感被证明是疼痛发展的保护因素，尤其是在长期随访中。结果表明，在研究、预防和治疗方法中应对社会心理因素时，应区分应激类型。
