Differences and Correlations of Anxiety, Sleep Quality, and Pressure-Pain Threshold between Patients with Chronic Low Back Pain and Asymptomatic People

Xu, Changming; Fu, Zhiwei; Wang, Juan; Wu, Bao; Wang, Xue-Qiang

doi:https://doi.org/10.1155/2022/8648584

Pain Research and Management

On this page

Abstract Introduction Materials and Methods Results Discussion Conclusion Data Availability Ethical Approval Consent Conflicts of Interest Authors’ Contributions Acknowledgments References Copyright Related Articles

Special Issue

Low Back Pain and Osteoarthritis Pain: Advanced Pathology and Novel Minimal Invasive Treatment 2021

View this Special Issue

Research Article | Open Access

Volume 2022 | Article ID 8648584 | https://doi.org/10.1155/2022/8648584

Differences and Correlations of Anxiety, Sleep Quality, and Pressure-Pain Threshold between Patients with Chronic Low Back Pain and Asymptomatic People

Changming Xu,^1,2Zhiwei Fu,³Juan Wang,^2,4Bao Wu,^2,5and Xue-Qiang Wang^2,6

Academic Editor: Ji Tu

Received07 Mar 2022

Accepted07 May 2022

Published17 May 2022

Abstract

Background. Chronic low back pain (CLBP) is a clinically common and expensive disease. Patients frequently take sick leaves because of pain and dysfunction, and their unpleasant life and work experiences cause psychological depression and anxiety and affect their quality of life. Sleep disturbance is a common problem among patients with low back pain (LBP) with more than 50% complaining about poor sleep quality. This study aimed to explore the correlations between anxiety, sleep quality, and pressure-pain threshold (PPT) and their differences between patients with CLBP and asymptomatic people. Methods. Forty patients with CLBP and 40 asymptomatic people were recruited. Relevant data, including State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Index, and PPT, were individually and independently collected by blinded physiotherapists with a practicing certificate and then statistically analyzed. An independent sample t-test was used to determine the intergroup differences between patients with CLBP and asymptomatic populations. Pearson correlation coefficient was employed for correlation analysis. Results. The CLBP group had significantly higher anxiety scores (41.64 ± 9.88 vs. 36.69 ± 8.31; t = −2.496, ) than the asymptomatic group. A significant difference was found in the total score of the Pittsburgh Sleep Quality Index (6.41 ± 2.43 vs. 5.09 ± 2.18; t = −2.628, ) but not in the trait anxiety (44.00 ± 7.83 vs. 42.67 ± 9.51; t = −0.695, ) of the two groups. State−Trait Anxiety Inventory showed a low to moderate negative correlation with PPT. No remarkable correlation was observed between Pittsburgh Sleep Quality Index and PPT. Conclusions. Patients with CLBP showed considerably worse state anxiety and sleep quality than asymptomatic people; however, no substantial difference in PPT was found between the two groups. The results suggest that in clinical practice, the focus should include pain and related social and psychological factors. CLBP treatment could be considered from multiple perspectives and disciplines.This trial is registered with Chinese Clinical Trial Registry (Trial registration: ChiCTR-TRC-13003701).

1. Introduction

Chronic low back pain (CLBP) is a clinically common and expensive disease [1, 2]. Its long course has generated huge medical expenditures in various countries [3]. When low back pain (LBP) lasts for more than 3 months, it is no longer regarded as a symptom but rather a disease caused by the interaction of factors that may differ from the initial cause [3]. LBP is usually caused by injury [4]. Spinal structural instability and intervertebral disc herniation can also occur in asymptomatic individuals. Therefore, degenerative changes in spinal structure and stability are not directly related to pain pathology [5–7]. A biopsychosocial model that includes related biological and nonbiological risk factors, such as negative beliefs about pain, anxiety, depression, emotional confusion, painful behaviors, and sleep quality, is suitable for clinical practice [8–10].

LBP usually does not manifest alone and may be accompanied by pain in other body parts [11, 12]. Patients frequently take sick leaves because of pain and dysfunction [13], and their unpleasant life and work experiences cause psychological depression and anxiety and affect their quality of life [14]. Chronic pain and anxiety coexist and may cause each other, forming a vicious cycle [15]. Some scholars [15, 16] designed a patient-centered treatment model that focuses on the biopsychosocial factors of patients. They found improvements in pain intensity, disability, quality of life, and self-efficacy of patients after the intervention compared with the control, but anxiety and stress were less ameliorated. On this basis, the correlation between psychosocial factors and CLBP must be further investigated.

Sleep disturbance is a common problem among patients with LBP with more than 50% complaining about poor sleep quality [17–19]. Reduced sleep disrupts the complete sleep cycle and may increase musculoskeletal pain and sensitivity to harmful stimuli [20]. Pain intensity and anxiety score can be enhanced by improving sleep quality in patients with chronic pain [21, 22]. Anxiety may also be related to pain intensity and sleep quality in patients with fibromyalgia [23]. Patients with CLBP may simultaneously experience anxiety, poor sleep quality, and pain, and these three affect each other.

Muscle pressure-pain threshold (PPT) refers to the pressure threshold at which a subject experiences pain [24]. Peripheral or central sensitization occurs with changes in pain intensity [25]. Moderate pain may cause changes in PPT and adaptations of the musculoskeletal system [26, 27]. Therefore, it can effectively provide objective values about changes in pain sensitivity in patients with CLBP [28]. Moreover, PPT is often used as an evaluation tool to evaluate the effect of related interventions on LBP in the research on the pain sensitivity of exercise [29–33]. However, few studies investigated whether patients with CLBP and asymptomatic people have differences in PPT [24–30]. Whether the changes in the muscle PPT of patients with CLBP are the result of anxiety or sleep disturbance or a factor that causes pain also remains unclear. This study aimed to explore the differences and correlations among anxiety, sleep quality, and PPT and their differences between patients with CLBP and asymptomatic people.

2. Materials and Methods

The relevant procedures and plans were reviewed and approved by the Ethics Committee of Shanghai University of Sports and then registered at the Chinese Clinical Trial Registry Trial registration: ChiCTR-TRC-13003701. The experiment was carried out at the Sports Rehabilitation Center of Shanghai University of Sports and the Rehabilitation Department of Renji Hospital affiliated with Shanghai Jiaotong University School of Medicine. Participants were recruited through online and offline methods, and the experiment was initiated after the patients signed the informed consent form.

2.1. Subjects

Among the 92 subjects recruited, 12 did not meet the inclusion criteria. Finally, 40 subjects with CLBP and 40 asymptomatic people were included. The sample size was calculated as previously described [26].

The inclusion criteria for the CLBP group were as follows: (1) 18–50 years old, (2) LBP for at least 3 months, (3) numerical rating scale (NRS) score ≥3, (4) Roland Morris Disability Questionnaire score ≥3, and (5) those that can sign the informed consent and complete relevant tests.

The inclusion criteria for the asymptomatic group were as follows: (1) 18–50 years old; (2) no history of LBP and no pain in other body parts during recruitment; and (3) those that can sign the informed consent and complete relevant tests.

The exclusion criteria for both groups were as follows: (1) currently taking analgesics and anesthetics; (2) addicted to smoking or alcohol; (3) cognitive impairment or psychological illness; (4) history of surgery; (5) current treatment for other clinical diseases, such as fractures, sprain, and cold; and (6) pregnant women.

Patients were withdrawn if (1) the subjects personally request a withdrawal from the study, (2) the subject cannot complete the test as required, (3) the symptoms of LBP worsened, or (4) the subject received other treatment.

2.2. Procedure

After recruitment, an equal number of subjects were recruited into the CLBP and asymptomatic groups. Relevant data, including State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Index, and PPT, were individually and independently collected by blinded physiotherapists with a practicing certificate and then statistically analyzed.

2.3. Outcome Measures

Baseline data consist of demographic information (age, gender, height, weight, and education) and self-reported physical activity (sitting for a long time; exercising regularly; and the duration, weekly frequency, and intensity of exercise). State-Trait Anxiety Inventory and Pittsburgh Sleep Quality Index were then measured.

PPT data (kgf) were collected using a handheld PPT tester (FDX 25 FORCE GAGE 25 × 0.02 Ibf) to apply pressure at a constant speed on specific muscle positions. The pressure stimulation was immediately stopped when the subject reported pain, and the corresponding value was recorded. The measurement was repeated four times for each position and then averaged. Prior to formal data collection, the subjects were familiarized with the measurement procedure in advance. Measurement was generally performed on the painful side of the subjects. If the pain site was symmetrical, then the dominant side was measured.

The test points in the waist [26] included the iliopsoas, quadratus lumborum, erector spinae, transversus abdominis, gluteus medius, and piriformis muscles. The proximal measurement positions included the levator scapula and rhomboid muscles. The distal measurement positions included the hamstring and gastrocnemius muscles.

2.4. Statistical Analysis

Microsoft Excel 2019 (Microsoft, Redmond, WA, USA) and IBM SPSS 20.0 (IBM Corp., Armonk, NY, USA) were used for data statistics and analysis. An independent sample t-test was applied to determine the intergroup differences between patients with CLBP and asymptomatic populations. The results were expressed as mean (M) ± standard deviation (SD) with corresponding t and values.

Pearson correlation coefficient was employed for correlation analysis, and the statistical results indicate the Pearson coefficient and corresponding value. was considered significantly different. An absolute value of the Pearson coefficient close to 1 indicates a strong correlation: 0.00–0.19 indicates very low correlation, 0.20–0.39 indicates low correlation, 0.40–0.69 indicates moderate correlation, 0.70–0.89 indicates high correlation, and 0.90–1.00 indicates extremely high correlation.

3. Results

Among the 92 recruited people, 12 did not meet the inclusion criteria and were excluded at the initial screening. Eighty subjects participated in the data collection. Subject matching at a ratio of 1 : 1 was adopted during grouping to exclude the influence of gender, age, and other factors. The patients with CLBP and asymptomatic populations showed consistent gender composition with no differences in baseline data.

3.1. Baseline Data

Baseline data included age, gender, height, weight, education, and self-reported exercise habits (including sedentary or not, regular training or not, duration of each training, weekly training frequency, and training intensity). No remarkable differences in baseline data were found between the two groups (Table 1).

PPT was measured in 10 muscles on the body surface: levator scapulae and rhomboid muscles in the proximal part of the body; iliopsoas, quadratus lumborum, erector spinae, transverse abdominis, gluteus maximus, and piriformis in the waist; and hamstrings and gastrocnemius muscles in the lower extremities. No considerable differences in PPTs at the 10 measured points were observed between the two groups (Table 2).

3.2. Differences in State-Trait Anxiety and Pittsburgh Sleep Quality Index

Compared with the asymptomatic group, the CLBP group had significantly higher state anxiety scores (41.64 ± 9.88 vs. 36.69 ± 8.31; t = −2.496, ). However, no significant difference in trait anxiety scores (44.00 ± 7.83 vs. 42.67 ± 9.51; t = −0.695, ) was found between the two groups (Table 3).

Significant difference in total Pittsburgh Sleep Quality Index scores (6.41 ± 2.43 vs. 5.09 ± 2.18; t = −2.628, ) was found between the two groups. The CLBP group had a significantly worse sleep disorder (1.41 ± 1.16 vs. 0.93 ± 0.39; t = −2.587, ) than the asymptomatic group. People with CLBP slept less (0.44 ± 0.64 vs. 0.20 ± 0.46; t = −1.961, ) and were more likely to have daytime dysfunction (1.90 ± 0.82 vs. 1.60 ± 0.69; t = −1.808, ) than asymptomatic people, but the difference was not significant. Hypnotics were consumed by the CLBP group but not by the asymptomatic group (0.08 ± 0.48 vs. 0.00 ± 0.00; t = −1.075, ). No significant differences in time to fall asleep (1.05 ± 0.86 vs. 1.16 ± 0.80; t = 0.578, ), sleep efficiency (0.28 ± 0.61 vs. 0.13 ± 0.41; t = −1.340, ), and sleep quality (1.26 ± 0.75 vs. 1.07 ± 0.65; t = −1.238, ) were observed between the two groups (Table 4).

3.3. Correlation among Anxiety, Sleep Quality, and PPT

State anxiety showed a moderate negative correlation with levator scapulae threshold in the CLBP group and low negative correlations with rhomboid, iliopsoas, quadratus lumborum, erector spinae, and transverse abdominis muscles. Trait anxiety had a moderate negative correlation with levator scapulae threshold in the CLBP group and low negative correlations with rhomboids, iliopsoas, quadratus lumborum, and erector spinae muscles. In the total sample size (CLBP + asymptomatic), the results of the correlation were similar to those for the CLBP group. No remarkable correlation was observed between the Pittsburgh Sleep Quality Index score and PPT (Table 5).

4. Discussion

In this study, the CLBP group had considerably higher state anxiety than the asymptomatic population, but no difference was found in trait anxiety. This finding suggests the similarities in the long-term personality traits between the CLBP and asymptomatic groups. Nevertheless, the anxiety state was affected by CLBP. Whether the persistence of pain state for a long time can affect both populations or is induced by the characteristics of intermittent CLBP episodes remains unclear. State anxiety is an independent predictor of CLBP [34]. Pain-related anxiety affects patients’ pain perception. Patients have the potential to catastrophize pain [35], increase the associated negative experience, and intensify their willingness to seek medical care [36]. A low to moderate negative correlation was found between state-trait anxiety scale and PPT, and no significant correlation was observed for lower extremity muscles. This finding indicates that individuals with stronger anxiety levels have lower PPT and a stronger willingness to report pain. Patients with CLBP are more intolerant to persistent painful stimuli and report a larger area of pain than asymptomatic people [26]. Differences in psychological status affect the patient’s experience of pain and decision-making for LBP in clinical practice, and patients without psychological disorders will achieve better outcomes than those experiencing these illnesses [37, 38].

The CLBP group had considerably worse sleep quality, sleep disturbance, and a certain degree of daytime dysfunction than the asymptomatic population. Only the CLBP group reported using hypnotic drugs, and no significant difference was observed between the two. These findings are similar to previous studies [39–41], which indicated that sleep disturbance in patients with CLBP is related to pain intensity; that is, every increase in the visual analog scale is associated with a 10% increase in the likelihood of reporting sleep disturbance [18, 42]. A weak association was observed between CLBP intensity and sleep disturbance, suggesting that other factors, such as anxiety, also contribute to sleep disturbance in patients with CLBP. A good night’s sleep provides only temporary relief [39], suggesting that comprehensive interventions for CLBP should include sleep quality, pain assessment, and coping. Sribastav et al. [19] pointed out that the patients with CLBP who experienced sleep disturbance had more severe anxiety, depression, and pain intensity and worse quality of life than those without sleep disturbance. Here, sleep quality is remarkably correlated with LBP severity but not with PPT. This result may be related to the small sample size. Hence, further research on this correlation is necessary.

No remarkable differences in PPT were observed. Moreira’s cross-sectional study [43] of 36 subjects found that PPT is substantially lower in patients with CLBP than in healthy subjects. Farasyn and Meeusen [44] conducted a cross-sectional analysis of 87 patients with CLBP and 64 healthy subjects and also found that PPT is considerably lower in patients with CLBP than in healthy subjects. O’Neill et al.study [45] analyzed 198 patients with CLBP and 44 controls and found that PPT and other pain sensitivity parameters are considerably lower in patients with CLBP than in the controls. Other studies [29, 46] reported similar results. The discrepancy in findings may be attributed to the differences between the definition for the control and asymptomatic populations and other factors, such as sample size and the subject’s age. The present results can only reflect the objective data of the samples in this study.

This study has limitations. It has a cross-sectional correlation design, and the subjects were relatively young (mostly 22 years). Subsequent studies should expand the sample size and add subjects from other age groups to produce representative results.

5. Conclusion

Patients with CLBP have considerably worse state anxiety and sleep quality than asymptomatic people; however, no remarkable difference in PPT was found between the two groups. State anxiety and trait anxiety showed a low to moderate negative correlation with PPT, and no remarkable correlation was observed between the Pittsburgh Sleep Quality Index score and PPT. The results suggest that in clinical practice, the focus should include pain and related social and psychological factors. CLBP treatment should be considered from multiple perspectives and disciplines.

Data Availability

The datasets are available from the corresponding author on reasonable request.

Ethical Approval

This research was approved by the Ethics Committee of the Shanghai University of Sport. Participants were informed of the experimental procedures and risks and provided a written informed consent prior to attending several familiarization sessions. All methods were carried out in accordance with relevant guidelines and regulations. Code of ethical approval: 2018069.

Not applicable.

Conflicts of Interest

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Authors’ Contributions

CM X and XQ W provided concept/idea/research design. CM X and ZW F wrote the article, contributed to project management, and contributed equally to this study. B W and J W contributed to data collection and provided data analysis. XQ W did consultation (including manuscript review before submission). The authors read and approved the final manuscript.

Acknowledgments

The authors gratefully acknowledge the Fok Ying-Tong Education Foundation of China (161092), the Scientific and Technological Research Program of the Shanghai Science and Technology Committee (fund number: 19080503100), and the Shanghai Key Laboratory of Human Performance (Shanghai University of Sport; fund number: 11DZ2261100).

References

A. C. Traeger, A. Qaseem, and J. H. McAuley, “Low back pain,” JAMA, vol. 326, no. 3, p. 286, 2021.
View at: Publisher Site | Google Scholar
R. Rubin, “Medicare proposes coverage of acupuncture for lower back pain,” JAMA, vol. 322, no. 8, p. 716, 2019.
View at: Publisher Site | Google Scholar
J. W. S. Vlaeyen, C. G. Maher, K. Wiech et al., “Low back pain,” Nature Reviews Disease Primers, vol. 4, no. 1, p. 52, 2018.
View at: Publisher Site | Google Scholar
B. Morlion, “Chronic low back pain: pharmacological, interventional and surgical strategies,” Nature Reviews Neurology, vol. 9, no. 8, pp. 462–473, 2013.
View at: Publisher Site | Google Scholar
D. Goubert, R. De Pauw, M. Meeus et al., “Lumbar muscle structure and function in chronic versus recurrent low back pain: a cross-sectional study,” The Spine Journal, vol. 17, no. 9, pp. 1285–1296, 2017.
View at: Publisher Site | Google Scholar
J. L. Dideriksen, L. Gizzi, F. Petzke, and D. Falla, “Deterministic accessory spinal movement in functional tasks characterizes individuals with low back pain,” Clinical Neurophysiology, vol. 125, no. 8, pp. 1663–1668, 2014.
View at: Publisher Site | Google Scholar
D. Goubert, J. V. Oosterwijck, M. Meeus, and L. Danneels, “Structural changes of lumbar muscles in non-specific low back pain: a systematic review,” Pain Physician, vol. 19, no. 7, pp. E985–E1000, 2016.
View at: Google Scholar
J. Guzmán, R. Esmail, K. Karjalainen, A. Malmivaara, E. Irvin, and C. Bombardier, “Multidisciplinary rehabilitation for chronic low back pain: systematic review,” BMJ, vol. 322, no. 7301, pp. 1511–1516, 2001.
View at: Publisher Site | Google Scholar
S. J. Kamper, A. T. Apeldoorn, A. Chiarotto et al., “Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: cochrane systematic review and meta-analysis,” BMJ, vol. 350, p. h444, 2015.
View at: Publisher Site | Google Scholar
N. E. Foster, J. R. Anema, D. Cherkin et al., “Prevention and treatment of low back pain: evidence, challenges, and promising directions,” Lancet (London, England), vol. 391, no. 10137, pp. 2368–2383, 2018.
View at: Publisher Site | Google Scholar
G. C. Miyamoto, C. W. C. Lin, C. M. N. Cabral, J. M. van Dongen, and M. W. van Tulder, “Cost-effectiveness of exercise therapy in the treatment of non-specific neck pain and low back pain: a systematic review with meta-analysis,” British Journal of Sports Medicine, vol. 53, no. 3, pp. 172–181, 2019.
View at: Publisher Site | Google Scholar
D. C. Cherkin and P. M. Herman, “Cognitive and mind-body therapies for chronic low back pain and neck pain,” JAMA Internal Medicine, vol. 178, no. 4, pp. 556-557, 2018.
View at: Publisher Site | Google Scholar
D. Steffens, C. G. Maher, L. S. M. Pereira et al., “Prevention of low back pain,” JAMA Internal Medicine, vol. 176, no. 2, pp. 199–208, 2016.
View at: Publisher Site | Google Scholar
P. Jellema, D. A. W. M. Van Der Windt, H. E. Van Der Horst, J. W. R. Twisk, W. A. B. Stalman, and L. M. Bouter, “Should treatment of (sub) acute low back pain be aimed at psychosocial prognostic factors? cluster randomised clinical trial in general practice,” BMJ, vol. 331, no. 7508, p. 84, 2005.
View at: Publisher Site | Google Scholar
T. Gardner, K. Refshauge, J. McAuley, M. Hubscher, S. Goodall, and L. Smith, “Combined education and patient-led goal setting intervention reduced chronic low back pain disability and intensity at 12 months: a randomised controlled trial,” British Journal of Sports Medicine, vol. 53, no. 22, pp. 1424–1431, 2019.
View at: Publisher Site | Google Scholar
R. M. V. Erp, I. P. J. Huijnen, J. A. Verbunt, and R. J. Smeets, “A biopsychosocial primary care intervention (back on track) versus primary care as usual in a subgroup of people with chronic low back pain: protocol for a randomised, controlled trial,” Journal of Physiotherapy, vol. 61, no. 3, p. 155, 2015.
View at: Publisher Site | Google Scholar
S. M. Alsaadi, J. H. McAuley, J. M. Hush, and C. G. Maher, “Prevalence of sleep disturbance in patients with low back pain,” European Spine Journal, vol. 20, no. 5, pp. 737–743, 2011.
View at: Publisher Site | Google Scholar
I. Uchmanowicz, A. Kołtuniuk, A. Stępień, B. Uchmanowicz, and J. Rosinczuk, “The influence of sleep disorders on the quality of life in patients with chronic low back pain,” Scandinavian Journal of Caring Sciences, vol. 33, no. 1, pp. 119–127, 2019.
View at: Publisher Site | Google Scholar
S. S. Sribastav, H. Peiheng, L. Jun et al., “Interplay among pain intensity, sleep disturbance and emotion in patients with non-specific low back pain,” PeerJ, vol. 5, Article ID e3282, 2017.
View at: Publisher Site | Google Scholar
W. Tiede, W. Magerl, U. Baumgärtner, B. Durrer, U. Ehlert, and R. D. Treede, “Sleep restriction attenuates amplitudes and attentional modulation of pain-related evoked potentials, but augments pain ratings in healthy volunteers,” Pain, vol. 148, no. 1, pp. 36–42, 2010.
View at: Publisher Site | Google Scholar
H. Skúladóttir, H. Sveinsdottir, J. E. Holden, T. J. Gunnarsdottir, S. Halldorsdottir, and A. Bjornsdottir, “Pain, sleep, and health-related quality of life after multidisciplinary intervention for chronic pain,” International Journal of Environmental Research and Public Health, vol. 18, no. 19, p. 10233, 2021.
View at: Publisher Site | Google Scholar
M. E. Bowen, X. Ji, and M. A. Griffioen, “Poor sleep predicts increased pain perception among adults with mild cognitive impairment,” Nursing Research, vol. 70, no. 4, pp. 310–316, 2021.
View at: Publisher Site | Google Scholar
B. Keskindag and M. Karaaziz, “The association between pain and sleep in fibromyalgia,” Saudi Medical Journal, vol. 38, no. 5, pp. 465–475, 2017.
View at: Publisher Site | Google Scholar
S. Finocchietti, K. Takahashi, K. Okada, Y. Watanabe, T. Graven-Nielsen, and K. Mizumura, “Deformation and pressure propagation in deep tissue during mechanical painful pressure stimulation,” Medical, & Biological Engineering & Computing, vol. 51, no. 1-2, pp. 113–122, 2013.
View at: Publisher Site | Google Scholar
U. Żywień, K. Barczyk-Pawelec, and T. Sipko, “Associated risk factors with low back pain in white-collar workers—a cross-sectional study,” Journal of Clinical Medicine, vol. 11, no. 5, p. 1275, 2022.
View at: Publisher Site | Google Scholar
C. Xu, Z. Fu, and X. Wang, “Effect of transversus abdominis muscle training on pressure-pain threshold in patients with chronic low back pain,” BMC Sports Science, Medicine and Rehabilitation, vol. 13, no. 1, pp. 1–15, 2021.
View at: Google Scholar
M. Imamura, J. Chen, S. R. Matsubayashi et al., “Changes in pressure pain threshold in patients with chronic nonspecific low back pain,” Spine, vol. 38, no. 24, pp. 2098–2107, 2013.
View at: Publisher Site | Google Scholar
H. L. den Bandt, W. D. Paulis, D. Beckwée, K. Ickmans, J. Nijs, and L. Voogt, “Pain mechanisms in low back pain: a systematic review with meta-analysis of mechanical quantitative sensory testing outcomes in people with nonspecific low back pain,” Journal of Orthopaedic & Sports Physical Therapy, vol. 49, no. 10, pp. 698–715, 2019.
View at: Publisher Site | Google Scholar
S. L. Aspinall, A. Jacques, C. Leboeuf-Yde, S. J. Etherington, and B. F. Walker, “Pressure pain threshold and temporal summation in adults with episodic and persistent low back pain trajectories: a secondary analysis at baseline and after lumbar manipulation or sham,” Chiropractic & Manual Therapies, vol. 28, no. 1, pp. 1–12, 2020.
View at: Google Scholar
S. L. Aspinall, C. Leboeuf-Yde, S. J. Etherington, and B. F. Walker, “Changes in pressure pain threshold and temporal summation in rapid responders and non-rapid responders after lumbar spinal manipulation and sham: a secondary analysis in adults with low back pain,” Musculoskeletal Science and Practice, vol. 47, Article ID 102137, 2020.
View at: Publisher Site | Google Scholar
K. Zheng, C. Chen, S. Yang, and X. Wang, “Aerobic exercise attenuates pain sensitivity: an event-related potential study,” Frontiers in Neuroscience, vol. 15, Article ID 735470, 2021.
View at: Publisher Site | Google Scholar
B. Wu, L. Zhou, C. Chen, J. Wang, L. Hu, and X. Wang, “Effects of exercise-induced hypoalgesia and its neural mechanisms,” Medicine & Science in Sports & Exercise, vol. 54, no. 2, pp. 220–231, 2022.
View at: Publisher Site | Google Scholar
M. S. Peng, R. Wang, Y. Z. Wang et al., “Efficacy of therapeutic aquatic exercise vs physical therapy modalities for patients with chronic low back pain,” JAMA Network Open, vol. 5, no. 1, Article ID e2142069, 2022.
View at: Publisher Site | Google Scholar
J. M. Hallegraeff, R. Kan, E. van Trijffel, and M. F. Reneman, “State anxiety improves prediction of pain and pain-related disability after 12 weeks in patients with acute low back pain: a cohort study,” Journal of Physiotherapy, vol. 66, no. 1, pp. 39–44, 2020.
View at: Publisher Site | Google Scholar
P. W. M. Marshall, S. Schabrun, and M. F. Knox, “Physical activity and the mediating effect of fear, depression, anxiety, and catastrophizing on pain related disability in people with chronic low back pain,” PLoS One, vol. 12, no. 7, Article ID e0180788, 2017.
View at: Publisher Site | Google Scholar
L. R. LaRowe, J. M. Powers, L. Garey, A. H. Rogers, M. J. Zvolensky, and J. W. Ditre, “Pain-related anxiety, sex, and co-use of alcohol and prescription opioids among adults with chronic low back pain,” Drug and Alcohol Dependence, vol. 214, Article ID 108171, 2020.
View at: Publisher Site | Google Scholar
F. P. Schwarm, M. Ott, J. Nagl et al., “Preoperative elevated levels for depression, anxiety, and subjective mental stress have no influence on outcome measures of peripheral nerve field stimulation for chronic low back pain—a prospective study,” Neuromodulation: Technology at the Neural Interface, vol. 24, no. 6, pp. 1042–1050, 2021.
View at: Publisher Site | Google Scholar
A. H. Bailes, R. Navlani, S. Koscumb et al., “Use of healthcare resources in patients with low back pain and comorbid depression or anxiety,” The Spine Journal, vol. 21, no. 9, pp. 1440–1449, 2021.
View at: Publisher Site | Google Scholar
J. I. Gerhart, J. W. Burns, K. M. Post et al., “Relationships between sleep quality and pain-related factors for people with chronic low back pain: tests of reciprocal and time of day effects,” Annals of Behavioral Medicine, vol. 51, no. 3, pp. 365–375, 2017.
View at: Publisher Site | Google Scholar
J. R. Chang, X. Wang, G. Lin, D. Samartzis, S. M. Pinto, and A. Y. Wong, “Are changes in sleep quality/quantity or baseline sleep parameters related to changes in clinical outcomes in patients with nonspecific chronic low back pain?: a systematic review,” The Clinical Journal of Pain, vol. 38, no. 4, pp. 292–307, 2022.
View at: Publisher Site | Google Scholar
F. M. Kovacs, J. Seco, A. Royuela et al., “The association between sleep quality, low back pain and disability: a prospective study in routine practice,” European Journal of Pain, vol. 22, no. 1, pp. 114–126, 2018.
View at: Publisher Site | Google Scholar
S. M. Alsaadi, J. H. McAuley, J. M. Hush et al., “Poor sleep quality is strongly associated with subsequent pain intensity in patients with acute low back pain,” Arthritis & Rheumatology, vol. 66, no. 5, pp. 1388–1394, 2014.
View at: Publisher Site | Google Scholar
L. P. C. Moreira, C. Mendoza, M. Barone, R. S. Rocha, R. Dias dos Santos, and F. A. Hazime, “Reduction in pain inhibitory modulation and cognitive-behavioral changes in patients with chronic low back pain: a case-control study,” Pain Management Nursing, vol. 22, no. 5, pp. 599–604, 2021.
View at: Publisher Site | Google Scholar
A. Farasyn and R. Meeusen, “The influence of non-specific low back pain on pressure pain thresholds and disability,” European Journal of Pain, vol. 9, no. 4, pp. 375–381, 2005.
View at: Publisher Site | Google Scholar
S. O’Neill, C. Manniche, T. Graven-Nielsen, and L. Arendt-Nielsen, “Association between a composite score of pain sensitivity and clinical parameters in low-back pain,” The Clinical Journal of Pain, vol. 30, no. 10, pp. 831–838, 2014.
View at: Publisher Site | Google Scholar
B. M. Wand, M. J. Catley, M. I. Rabey, P. B. O’Sullivan, N. E. O'Connell, and A. J. Smith, “Disrupted self-perception in people with chronic low back pain: further evaluation of the fremantle back awareness questionnaire,” The Journal of Pain, vol. 17, no. 9, pp. 1001–1012, 2016.
View at: Publisher Site | Google Scholar

Copyright

Copyright © 2022 Changming Xu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

PDF Download Citation

Download other formats

Order printed copies

Views

585

Downloads

681

Citations