Effects of Individual Psychological Factors and Cumulative Psychological Distress on Prospective Pain Quality in Older Adults with Chronic Low Back Pain.

Objective: Although pain quality may be a component of the geriatric chronic pain experience that influences disability, no research has investigated the psychological underpinnings of pain quality in any geriatric chronic pain population. We sought to address this knowledge gap by examining associations between both general (i.e., depressive symptoms) and pain-specific psychological risk factors (i.e., fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) and prospective pain quality in older adults with chronic low back pain.

Methods: Questionnaires for each psychological factor were collected at baseline, while pain quality was measured by the McGill Pain Questionnaire at baseline and 12-months. Preliminary analyses identified pain catastrophizing as the individual factor with the highest correlation to future pain quality for subsequent analyses. To assess if baseline psychological factors were cumulatively associated with 12-month pain quality, questionnaire values were entered into principal component analysis to yield a combined psychological component score. Robust regression models with HC3 standard errors were used to examine associations between baseline psychological risk factors (both individually and cumulatively) and prospective pain quality.

Results: In adjusted analyses, higher baseline pain catastrophizing independently predicted worse pain quality at 12-months (b=0.342, t=4.225, P<0.001). Similarly, higher baseline psychological component scores were independently associated with worse prospective pain quality after adjustment (b=3.816, t=4.518, P<0.001).

Discussion: The combined psychological component score had comparatively stronger predictive ability than pain catastrophizing alone; however, overall model prediction was modest, suggesting that future research is needed to identify other biopsychosocial variables that may impact pain quality in the geriatric chronic LBP population.