Pinto Sabina M, Cheung Jason P Y, Samartzis Dino, Karppinen Jaro, Zheng Yong-Ping, Pang Marco Y C, Wong Arnold Y L
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.
Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
Front Psychiatry. 2022 Apr 15;13:809891. doi: 10.3389/fpsyt.2022.809891. eCollection 2022.
Lumbar multifidus muscle (LMM) dysfunction is thought to be related to pain and/or disability in people with chronic low back pain (CLBP). Although psychosocial factors play a major role in pain/disability, they are seldom considered as confounders in analyzing the association between LMM and CLBP.
This study aimed to determine: (1) differences in psychological factors, insomnia, and LMM characteristics between people with and without CLBP; (2) associations between psychological factors, insomnia, or LMM characteristics and low back pain (LBP) intensity or LBP-related disability in people with CLBP; and (3) whether LMM characteristics are related to LBP symptoms in people with CLBP after considering confounders.
Seventy-eight volunteers with CLBP and 73 without CLBP provided sociodemographic information, filled the 11-point numeric pain rating scale and Roland-Morris disability questionnaire (RMDQ). They completed the Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS), Fear Avoidance Belief Questionnaire (FAB), and Insomnia Severity Index Scale (ISI). Resting and contracted thickness of LMM at L4-S1 levels were measured from brightness-mode ultrasound images. Percent thickness changes of LMM at L4-S1 levels during contraction were calculated. Resting LMM stiffness at L4-S1 was measured by shear wave elastography. Associations among LMM, psychosocial or insomnia parameters and clinical outcomes were analyzed by univariate and multivariate analyses.
People with CLBP demonstrated significantly higher LBP-intensity, RMDQ, HADS, FAB, PCS, and ISI scores than asymptomatic controls ( < 0.05). The former also had significantly smaller percent thickness changes of LMM at L4/L5 during contraction. LBP-intensity was positively related to scores of PCS-total, PCS-helplessness, FAB-total, FAB-work, and ISI in people with CLBP ( < 0.05). RMDQ scores were positively associated with the scores of HADS-total, HADS-depression, PCS-total, FAB-total, FAB-physical activity, PCS-helplessness, and ISI in people with CLBP ( < 0.05). FAB-work and ISI scores together explained 24% of LBP-intensity. FAB-total scores alone explained 34% of variance of LBP-related disability in people with CLBP.
More fear-avoidance belief or insomnia is related to greater LBP-intensity and/or LBP-related disability in people with CLBP. Although people with CLBP were thought to have aberrant LMM morphometry/function, no LMM characteristics were related to LBP-intensity or LBP-related disability after considering other confounders.
腰椎多裂肌（LMM）功能障碍被认为与慢性下腰痛（CLBP）患者的疼痛和/或残疾有关。尽管社会心理因素在疼痛/残疾中起主要作用，但在分析LMM与CLBP之间的关联时，它们很少被视为混杂因素。
本研究旨在确定：（1）CLBP患者与非CLBP患者在心理因素、失眠和LMM特征方面的差异；（2）CLBP患者的心理因素、失眠或LMM特征与下腰痛（LBP）强度或LBP相关残疾之间的关联；（3）在考虑混杂因素后，CLBP患者的LMM特征是否与LBP症状相关。
78名CLBP志愿者和73名非CLBP志愿者提供了社会人口统计学信息，填写了11点数字疼痛评分量表和罗兰-莫里斯残疾问卷（RMDQ）。他们完成了医院焦虑抑郁量表（HADS）、疼痛灾难化量表（PCS）、恐惧回避信念问卷（FAB）和失眠严重程度指数量表（ISI）。从亮度模式超声图像中测量L4-S1水平的LMM静息和收缩厚度。计算L4-S1水平LMM在收缩过程中的厚度变化百分比。通过剪切波弹性成像测量L4-S1水平的LMM静息刚度。通过单因素和多因素分析分析LMM、社会心理或失眠参数与临床结局之间的关联。
CLBP患者的LBP强度、RMDQ、HADS、FAB、PCS和ISI评分显著高于无症状对照组（<0.05）。前者在收缩过程中L4/L5水平的LMM厚度变化百分比也显著较小。CLBP患者的LBP强度与PCS总分、PCS无助感、FAB总分、FAB工作和ISI评分呈正相关（<0.05）。CLBP患者的RMDQ评分与HADS总分、HADS抑郁、PCS总分、FAB总分、FAB身体活动、PCS无助感和ISI评分呈正相关（<0.05）。FAB工作和ISI评分共同解释了LBP强度的24%。FAB总分单独解释了CLBP患者LBP相关残疾变异的34%。
更多的恐惧回避信念或失眠与CLBP患者更高的LBP强度和/或LBP相关残疾有关。尽管CLBP患者被认为存在LMM形态学/功能异常，但在考虑其他混杂因素后，没有LMM特征与LBP强度或LBP相关残疾相关。
