Cross-sectional and Longitudinal Associations of Low-back Pain
and Related Disability with Psychological Distress Among
Patients Enrolled in the UCLA Low-Back Pain Study

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

FROM:   J Clin Epidemiol. 2003 (May);   56 (5):   463–471

Eric L. Hurwitz, DC, PhD, Hal Morgenstern, PhD

School of Public Health,
Department of Epidemiology,
University of California-Los Angeles,
Box 951772,
Los Angeles, CA 90095-1772, USA.
ehurwitz@ucla.edu

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The objectives of the study are to test the hypotheses that psychological distress affects subsequent low-back pain, and pain affects subsequent distress. Six hundred eighty-one participants in a randomized clinical trial of low-back pain treatments were followed for 18 months with assessments for pain, disability, and psychological distress at 6 weeks and 6, 12, and 18 months. Multivariable logistic regression modeling with generalized estimating equations was used to estimate effects.

Current pain and disability increased the odds of subsequent psychological distress [pain: adjusted odds ratio (OR)=1.36, 95% confidence interval (CI)=1.07, 1.72; disability: adjusted OR=1.23, 95% CI=0.98, 1.55], and current distress increased the odds of subsequent pain and disability (pain: adjusted OR=1.51, 95% CI=1.24, 1.86; disability: adjusted OR=1.49; 95% CI=1.20, 1.85).

Cross-sectional associations were much stronger than the longitudinal associations, suggesting bias in the former due to selection factors and/or temporal ambiguity. The longitudinal findings suggest that pain/disability and psychological distress may be causes and consequences of each other, although the associations are small.

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