Do psychological factors predict outcome in both low back pain and shoulder pain?

Danielle A.W.M. van der Windt ^1*, Ton Kuijpers ², Petra Jellema ¹, Geert J.M.G. van der Heijden ³ and Lex M Bouter ¹

¹ EMGO Institute, VU University Medical Centre, Netherlands
² Amsterdam School of Allied Health Care Education, Netherlands
³ Universitair Medisch Centrum Utrecht, Netherlands

^* To whom correspondence should be addressed. E-mail: dawm.vanderwindt{at}vumc.nl.

Accepted 4 August 2006

Abstract

Objective:Psychological factors are assumed to predict persistent or recurrent musculoskeletal pain. We explored the influence of psychological factors in patients with low back pain (LBP) or shoulder pain (SP) to study whether there is similarity regarding the factors that predict persisting pain and disability.

Methods:Patients presenting in primary care with a new episode of SP or non-specific (sub)acute LBP were enrolled in a prospective study. In both patient groups pain catastrophising, distress, somatisation, and fear- avoidance beliefs were measured at baseline. Primary outcome measures at three months were 1) persistent symptoms, and 2) less than 30% reduction in functional disability. Multivariable logistic regression analysis was used to study the associations between psychological factors and outcome.

Results:A total of 587 patients with SP and 171 patients with LBP were enrolled in the study. In patients with SP most associations of psychological factors with outcome were weak and not statistically significant. Only in patients with longer symptom duration at baseline (>3 months) higher scores on catastrophising were significantly associated with persistent symptoms. In patients with LBP psychological factors were more strongly associated with poor outcome, although most associations were not statistically significant.

Conclusion:The results show that psychological factors, with the exception of fear-avoidance beliefs, are more strongly associated with persistent pain and disability in patients with LBP than in SP. This seems to indicate that in a primary care population the influence of psychological factors on outcome may vary across patients with different types of pain.

Keywords: low back pain, primary health care, prognosis, psychological factors, shoulder pain

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