Iberoamerican Journal of Medicine
Iberoamerican Journal of Medicine
Original article

Association of pain intensity and psychological factors among patients with chronic low back pain (LBP). A correlational cross-sectional study

Asociación de la intensidad del dolor y factores psicológicos entre pacientes con dolor lumbar crónico (DLC). Un estudio transversal correlacional

Sebastián Martín Pérez, Diego Zárate de Lupgens, Marcos Carrillo Pagés, Juan José Gómez Santaella, José Luis Alonso Pérez a, Isidro Martín Pérez

Downloads: 5
Views: 1123


Introduction: Chronic low back pain (cLBP) is associated with a dynamic interaction of multiple psychological factors that act as predictors of recovery time. Our goal was to quantify the association between pain intensity and psychological variables.
Material and methods: A cross-sectional study using convenience sampling was conducted at Universidad Europea de Canarias (Spain) between January 24, 2022 and June 10, 2022. In addition, adults and children with cLBP older than 13 years with cLBP for at least 12 weeks of symptoms were included. Finally, the descriptive analysis and the calculation of the correlation coefficients of the data was carried out with SPSS v.28.0.
Results: We recruited 146 subjects (n=85 women, 58.3%; n=61 men,41.7%) aged 50.4 ± 12.21 years suffering from cLBP with a moderate pain intensity (7.02±0.188), kinesiophobia (22.79 ± 0.559), catastrophism (13.42 ± 0.897), anxiety (24.47±0.560) and the quality of life SF36-PF (65.65±2.291), SF36-PR (48.03±2.727), SF36-BP (33.14±1.566), SF36-GH (43.98±1.873), SF36-V (48.56±1.812), SF36-SF (61.39±2.353), SF36-ER (76.29±2.043) and SF36-MH (49.76±1.666). Pain intensity in cLBP patients was negatively and moderately correlated with SF36-BP score (Pearson's r = -0.561, p < 0.001). In addition, the main variable was negatively and weakly correlated with SF36-PF (Pearson's r= -0.395, p<.001), SF36-PR (Pearson's r=-0.433, p<.001), SF36-V (Pearson's r = -0.260, p = 0.006), SF36-GH (Pearson's r = -0.203, p=0.032), SF36-SF (Pearson's r=-0.215, p=0.024). and SF36-MH (Pearson's r= -0.203, p = 0.032). Furthermore, pain intensity showed positive and weak with kinesiophobia score (Pearson’s r=0.310, p<.001) and positive and very weak with catastrophism (Pearson’s r=0.136, p<.001). In contrast, there was not correlation between pain intensity and anxiety in cLBP subjects (Pearson’s r=0.025, p=0.794).
Conclusions: Psychological variables were not associated with pain intensity in patients with cLBP. However, physical perception of pain was the only variable that remained moderately linearly associated with pain intensity.


Chronic low back pain; Psychological factors; Quality of life


Introducción: El dolor lumbar crónico (dolor lumbar crónico) está asociado a una interacción dinámica de múltiples factores psicológicos que actúan como predictores del tiempo de recuperación. Nuestro objetivo fue cuantificar la asociación entre la intensidad del dolor y las variables psicológicas.
Material y métodos: Se realizó un estudio transversal mediante muestreo por conveniencia en la Universidad Europea de Canarias (España) entre el 24 de enero de 2022 y el 10 de junio de 2022. Además, adultos y niños mayores de 13 años con dolor lumbar crónico con dolor lumbar crónico durante al menos Se incluyeron 12 semanas de síntomas. Finalmente, el análisis descriptivo y el cálculo de los coeficientes de correlación de los datos se realizó con SPSS v.28.0.
Resultados: Se reclutaron 146 sujetos (n=85 mujeres, 58,3 %; n=61 hombres, 41,7 %) de 50,4 ± 12,21 años que sufrían dolor lumbar crónico con intensidad de dolor moderada (7,02 ± 0,188), cinesiofobia (22,79 ± 0,559), catastrofismo (13,42±0,897), ansiedad (24,47±0,560) y calidad de vida SF36-PF (65,65±2,291), SF36-PR (48,03±2,727), SF36-BP (33,14±1,566), SF36-GH (43,98± 1,873), SF36-V (48,56±1,812), SF36-SF (61,39±2,353), SF36-ER (76,29±2,043) y SF36-MH (49,76±1,666). La intensidad del dolor en pacientes con dolor lumbar crónico se correlacionó negativa y moderadamente con la puntuación SF36-BP (r de Pearson = -0,561, p < 0,001). Además, la variable principal se correlacionó negativa y débilmente con SF36-PF (r de Pearson= -0.395, p<.001), SF36-PR (r de Pearson=-0.433, p<.001), SF36-V (r de Pearson=-0.433, p<.001). = -0,260, p = 0,006), SF36-GH (r de Pearson = -0,203, p=0,032), SF36-SF (r de Pearson = -0,215, p=0,024). y SF36-MH (r de Pearson = -0,203, p = 0,032). Además, la intensidad del dolor mostró puntuación positiva y débil con kinesiofobia (r de Pearson = 0,310, p < 0,001) y positiva y muy débil con catastrofismo (r de Pearson = 0,136, p < 0,001). Por el contrario, no hubo correlación entre la intensidad del dolor y la ansiedad en sujetos cLBP (r de Pearson = 0,025, p = 0,794).
Conclusiones: Las variables psicológicas no se asociaron con la intensidad del dolor en pacientes con dolor lumbar crónico. Sin embargo, la percepción física del dolor fue la única variable que permaneció moderadamente asociada linealmente con la intensidad del dolor.

Palabras clave

Dolor lumbar crónico; Factores psicológicos; Calidad de vida


1. Vlaeyen JWS, Maher CG, Wiech K, Van Zundert J, Meloto CB, Diatchenko L, et al. Low back pain. Nat Rev Dis Primers. 2018;4(1):52. doi: 10.1038/s41572-018-0052-1.
2. Ramond-Roquin A, Bouton C, Bègue C, Petit A, Roquelaure Y, Huez JF. Psychosocial Risk Factors, Interventions, and Comorbidity in Patients with Non-Specific Low Back Pain in Primary Care: Need for Comprehensive and Patient-Centered Care. Front Med (Lausanne). 2015;2:73. doi: 10.3389/fmed.2015.00073.
3. Jenkins LC, Chang WJ, Buscemi V, Liston M, Skippen P, Cashin AG, et al. Low Somatosensory Cortex Excitability in the Acute Stage of Low Back Pain Causes Chronic Pain. J Pain. 2022;23(2):289-304. doi: 10.1016/j.jpain.2021.08.003.
4. Steffens D, Maher CG, Ferreira ML, Hancock MJ, Glass T, Latimer J. Clinicians' views on factors that trigger a sudden onset of low back pain. Eur Spine J. 2014;23(3):512-9. doi: 10.1007/s00586-013-3120-y.
5. Hansen MS, Horjales-Araujo E, Dahl JB. Associations between psychological variables and pain in experimental pain models. A systematic review. Acta Anaesthesiol Scand. 2015;59(9):1094-102. doi: 10.1111/aas.12555.
6. Othman R, Dassanayake S, Jayakaran P, Tumilty S, Swain N, Mani R. Relationships Between Psychological, Social, Physical Activity, and Sleep Measures and Somatosensory Function in Individuals With Spinal Pain: A Systematic Review and Meta-analysis. Clin J Pain. 2020;36(2):124-34. doi: 10.1097/AJP.0000000000000775.
7. Luque-Suarez A, Martinez-Calderon J, Falla D. Role of kinesiophobia on pain, disability, and quality of life in people suffering from chronic musculoskeletal pain: a systematic review. Br J Sports Med. 2019;53(9):554-9. doi: 10.1136/bjsports-2017-098673.
8. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010. The Lancet. 2012;380(9859). doi: 10.1016/S0140-6736(12)61729-2.
9. Leysen M, Nijs J, Van Wilgen P, Demoulin C, Dankaerts W, Danneels L, et al. Attitudes, and beliefs on low back pain in physical therapy education: A cross-sectional study. Braz J Phys Ther. 2021;25(3):319-28. doi: 10.1016/j.bjpt.2020.08.002.
10. Hallegraeff JM, Van Zweden L, Oostendorp RA, Van Trijffel E. Psychological assessments by manual physiotherapists in the Netherlands in patients with nonspecific low back pain. J Man Manip Ther. 2021;29(5):310-7. doi: 10.1080/10669817.2021.1919283.
11. Malfliet A, Kregel J, Meeus M, Danneels L, Cagnie B, Roussel N, et al. Patients With Chronic Spinal Pain Benefit From Pain Neuroscience Education Regardless the Self-Reported Signs of Central Sensitization: Secondary Analysis of a Randomized Controlled Multicenter Trial. PM&R. 2018;10(12):1330-43.e1. doi: 10.1016/j.pmrj.2018.04.010.
12. Galan-Martin MA, Montero-Cuadrado F, Lluch-Girbes E, Coca-López MC, Mayo-Iscar A, Cuesta-Vargas A. Pain Neuroscience Education and
Physical Therapeutic Exercise for Patients with Chronic Spinal Pain in Spanish Physiotherapy Primary Care: A Pragmatic Randomized Controlled Trial. J Clin Med. 2020;9(4):1201. doi: 10.3390/jcm9041201.
13. Jones KC, Tocco EC, Marshall AN, Valovich McLeod TC, Welch Bacon CE. Pain Education With Therapeutic Exercise in Chronic Nonspecific Low Back Pain Rehabilitation: A Critically Appraised Topic. J Sport Rehabil. 2020;29(8):1204-9. doi: 10.1123/jsr.2019-0345.
14. Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine (Phila Pa 1976). 2005;30(11):1331-4. doi: 10.1097/01.brs.0000164099.92112.29.
15. Ishak NA, Zahari Z, Justine M. Kinesiophobia, Pain, Muscle Functions, and Functional Performances among Older Persons with Low Back Pain. Pain Res Treat. 2017:3489617. doi: 10.1155/2017/3489617.
16. Gómez-Pérez L, López-Martínez AE, Ruiz-Párraga GT. Psychometric Properties of the Spanish Version of the Tampa Scale for Kinesiophobia (TSK). J Pain. 2011;12(4):425-35. doi: 10.1016/j.jpain.2010.08.004.
17. Hapidou EG, O'Brien MA, Pierrynowski MR, de Las Heras E, Patel M, Patla T. Fear and Avoidance of Movement in People with Chronic Pain: Psychometric Properties of the 11-Item Tampa Scale for Kinesiophobia (TSK-11). Physiother Can. 2012;64(3):235-41. doi: 10.3138/ptc.2011-10.
18. Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: Development and Validation. Psychol Assess. 1995;7(4). doi: 10.1037/1040-3590.7.4.524.
19. Lamé IE, Peters ML, Kessels AG, Van Kleef M, Patijn J. Test-retest stability of the Pain Catastrophizing Scale and the Tampa Scale for Kinesiophobia in chronic pain over a longer period of time. J Health Psychol. 2008;13(6):820-6. doi: 10.1177/1359105308093866.
20. Spielberger, CD. Assessment of state and trait anxiety: Conceptual and methodological issues. South Psychol. 1985;2(4):6-16.
21. Fountoulakis KN, Papadopoulou M, Kleanthous S, Papadopoulou A, Bizeli V, Nimatoudis I, et al. Reliability and psychometric properties of the Greek translation of the State-Trait Anxiety Inventory form Y: preliminary data. Ann Gen Psychiatry. 2006;5:2. doi: 10.1186/1744-859X-5-2.
22. Gustafson LW, Gabel P, Hammer A, Lauridsen HH, Petersen LK, Andersen B, et al. Validity and reliability of State-Trait Anxiety Inventory in Danish women aged 45 years and older with abnormal cervical screening results. BMC Med Res Methodol. 2020;20(1):89. doi: 10.1186/s12874-020-00982-4.
23. Salazar FR, Bernabé E. The Spanish SF-36 in Peru: factor structure, construct validity, and internal consistency. Asia Pac J Public Health. 2015;27(2):NP2372-80. doi: 10.1177/1010539511432879.
24. Romero Massa E. [Reliability of the SF-36 questionnaire in post acute myocardial infarction patients from the city of Cartagena de Indias, Colombia]. Rev Colom Cardiol. 2010;17(2):41-6. doi: 10.1016/S0120-5633(10)70218-7.
25. Comachio J, Magalhães MO, Campos Carvalho E, Silva APM, Marques AP. A cross-sectional study of associations between kinesiophobia, pain, disability, and quality of life in patients with chronic low back pain. Adv Rheumatol. 2018;58(1):8. doi: 10.1186/s42358-018-0011-2.
26. Alaca N, Kaba H, Atalay A. Associations between the severity of disability level and fear of movement and pain beliefs in patients with chronic low back pain. J Back Musculoskelet Rehabil. 2020;33(5):785-91. doi: 10.3233/BMR-171039.
27. Swinkels-Meewisse IEJ, Roelofs J, Oostendorp RAB, Verbeek ALM, Vlaeyen JWS. Acute low back pain: pain-related fear and pain catastrophizing influence physical performance and perceived disability. Pain. 2006;120(1-2):36-43. doi: 10.1016/j.pain.2005.10.005.
28. Wertli MM, Eugster R, Held U, Steurer J, Kofmehl R, Weiser S. Catastrophizing-a prognostic factor for outcome in patients with low back pain: a systematic review. Spine J. 2014;14(11):2639-57. doi: 10.1016/j.spinee.2014.03.003.
29. Kovacs FM, Seco J, Royuela A, Peña A, Muriel A; Spanish Back Pain Research Network. The correlation between pain, catastrophizing, and disability in subacute and chronic low back pain: a study in the routine clinical practice of the Spanish National Health Service. Spine (Phila Pa 1976). 2011;36(4):339-45. doi: 10.1097/BRS.0b013e3181cfba29.
30. Sullivan MJL, Stanish W, Waite H, Sullivan M, Tripp DA. Catastrophizing, pain, and disability in patients with soft-tissue injuries. Pain. 1998;77(3):253-60. doi: 10.1016/S0304-3959(98)00097-9.
31. Suliman Alkhwaldeh ZE, Al Wahab Abuhmaidan YA.The Relationship between Levels of Pain, Anxiety and Depression with the Health-Related Quality of Life among Chronic Low Back Pain Patients. Int J Humanit Soc Sci. 2019;9(5):167-77. doi: 10.30845/ijhss.v9n5p21.
32. Kovacs FM, Abraira V, Zamora J, Teresa Gil del Real M, Llobera J, Fernández C et al. Correlation between pain, disability, and quality of life in
patients with common low back pain. Spine (Phila Pa 1976). 2004;29(2):206-10. doi: 10.1097/01.BRS.0000107235.47465.08.
33. Nasution IK, Lubis NDA, Amelia S., Hocin K. The correlation of pain intensity and quality of life in chronic LBP patients in Adam Malik general hospital. Earth Environ Sci. 2018;125:012183. doi: 10.1088/1755-1315/125/1/012183.

Submitted date:

Reviewed date:

Accepted date:

Publication date:

6363b398a953952e76132754 iberoamericanjm Articles
Links & Downloads

Iberoam J Med

Share this page
Page Sections