Introduction
A multidisciplinary approach to pain management for patients with chronic musculoskeletal pain, including low back pain, is implemented at the Pain Management Center, Hoshi General Hospital, Japan. We consistently evaluate not only biological pain factors but also pain levels, psychosocial factors associated with pain, and QOL using questionnaires. We usually investigate the self-entry-style outcomes related to pain at first examination before treatment, three and six months after treatment. However, it is unclear which psychosocial factors are associated with improving the degrees of pain. The purpose of this study is to explore the predictive psychosocial factors to improve the degrees of pain evaluated before multidisciplinary pain treatment for chronic musculoskeletal pain, including low back pain.
Methods
This study was a cohort study. Participants were 98 patients with valid responses from July 2015 to March 2023. Data collected included participants’ age and scores on the Brief Pain Inventory (BPI), Pain Catastrophizing Scale (PCS), Pain Disability Assessment Scale (PDAS), Hospital Anxiety and Depression Scale (HADS), Pain Self-Efficacy Questionnaire (PSEQ), EuroQol Five Dimensions Questionnaire (EQ-5D) and Athens Insomnia Scale (AIS). For the statistical analyses, we performed univariate and/or multivariate logistic regression analysis with the forced entry method. We classified the dependent variable into two groups: one is the improvement group as 1, and the other is the aggravation or no change group as 0. We determined the entry variable after the confirmation of the correction between the independent variable and the dependent variables. Finally, we analyzed the check-square test in order to investigate the ratio regarding the sex for the improvement group and the aggravation or no change group, and the attribution of ICD11 classification.
All analyses were performed using the IBM SPSS version 25. We considered p-values less than 0.05 to be statistically significant in the variance analyses.
Results
For the statistical analysis by the check-square test, there was not a significant difference for gender and ICD11 classification. For the multivariate logistic regression analysis with the forced entry method, we could select the rumination, subscale of PCS, as the dependent variable which affects the improvement group and/or the aggravation or no change group. The odds ratio was 0.868 (0.755-0.998: 95% confidence interval).
Discussion
The rumination, subscale of PCS, statistically significantly participates in the improvement, aggravation, and no change for pain. We clarified that the lower score of the rumination, subscale of PCS, in the evaluation items which was performed at the first examination of our hospital, suggest improving the degree of pain average at six months after treatment. In conclusion, we would pay attention to the rumination, subscale of PCS, at the first examination because it is effective for improving the degree of pain to cure the rumination intensively.