Pereira Nery Ellen C H, Rocha Nelson P, Cruz Vitor T, Silva Anabela G
Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.
IEETA and Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.
Pain Pract. 2023 Apr;23(4):399-408. doi: 10.1111/papr.13194. Epub 2022 Dec 25.
This study aimed to identify and assess the evidence on the association between idiopathic chronic low back pain (LBP) and cognitive function in individuals with LBP. A secondary aim was to explore whether changes in cognitive function are associated with pain characteristics and psychological factors (eg, catastrophizing and fear of movement). Eleven studies were included in this systematic review, and four meta-analyses were conducted. Low to very low-quality evidence suggests impaired cognitive function in individuals with LBP compared to asymptomatic controls for problem solving (k = 5; d = 0.33; CI = 0.16-0.50; z = 3.85 p = 0.0001), speed of information processing (k = 5; d = 0.44; CI = 0.22-0.65; z = 4.02 p < 0.0001), working memory (k = 6; d = 0.50; CI = 0.34-0.66; z = 6.09 p < 0.0001), and delayed memory (k = 3; d = 0.34; CI = 0.07-0.6, z = 2.49 p = 0.02). The association between LBP intensity and psychological factors and cognitive function was inconclusive. More studies are needed to explore these associations and improve evidence in this field. The results of this study suggest that cognitive aspects should be considered during the rehabilitation process of patients with LBP and raise further questions, including whether individuals with LBP are at a greater risk of developing dementia or whether targeting cognitive function will increase the probability of success of LBP treatment. These questions should, also, be considered in future studies.
本研究旨在识别和评估有关特发性慢性腰痛（LBP）与腰痛患者认知功能之间关联的证据。次要目的是探讨认知功能的变化是否与疼痛特征和心理因素（如灾难化思维和运动恐惧）相关。本系统评价纳入了11项研究，并进行了四项荟萃分析。低至极低质量的证据表明，与无症状对照组相比，腰痛患者在解决问题方面的认知功能受损（k = 5；d = 0.33；CI = 0.16 - 0.50；z = 3.85；p = 0.0001），信息处理速度（k = 5；d = 0.44；CI = 0.22 - 0.65；z = 4.02；p < 0.0001），工作记忆（k = 6；d = 0.50；CI = 0.34 - 0.66；z = 6.09；p < 0.0001）和延迟记忆（k = 3；d = 0.34；CI = 0.07 - 0.6；z = 2.49；p = 0.02）。腰痛强度与心理因素和认知功能之间的关联尚无定论。需要更多研究来探索这些关联并改善该领域的证据。本研究结果表明，在腰痛患者的康复过程中应考虑认知方面，并提出了进一步的问题，包括腰痛患者患痴呆症的风险是否更高，或者针对认知功能是否会增加腰痛治疗成功的可能性。这些问题在未来的研究中也应予以考虑。
