Burnout et lombalgies chroniques liées au travail : l’importance des dimensions interpersonnelles comme facteurs de risque

Abstract

ObjectivesChronic exposure to stressful situations at work alters the health of workers and can lead to the development of specific forms of physical suffering (as low-back pain) and psychological suffering (as burnout). Scientific literature is quite poor regarding the joint study of burnout and chronic low-back pain or chronic pain. However, they seem to share some common etiopathogenic hypotheses. Moreover, research on chronic low-back pain reveals many risk factors (including beliefs such as catastrophism and fear-avoidance) as predictor of chronification and development of disability. But, the prognostic value of these factors prove to be weak if they are considered in an individual way. Current research must then be viewed in a multidimensional perspective. Thus, this research aims to study the links between burnout, pain and disability within a population of chronic low-back pain workers. MethodsThe study was carried out with 256 patients with chronic low-back pain attending the regional organization offering support and expertise called “Lombaction”, part of the occupational diseases consultation department of Angers University Hospital. The average age is 41,74 years. All the variables were assessed through a booklet of validated questionnaires: pain intensity with visual analog scale, functional repercussions with Dallas Pain Questionnaire, burnout with Maslach Burnout Inventory (MBI), fear-avoidance beliefs with Fear-Avoidance Beliefs Questionnaire (FABQ), and catastrophism with Pain-Catastrophism Scale (PCS). Variance, correlation and multiple regression analysis were performed with SPSS Software. ResultsRisk factors levels (i.e. fear-avoidance beliefs and catastrophism) significantly contribute to increase levels of pain intensity and functional repercussions (P<.01) with explained variance percentages ranging from 13 to 30 %. Moreover, work-related fear-avoidance beliefs have a high predictive value. The different dimensions of burnout are related to the variables related to pain and disability, the emotional exhaustion explaining 3 to 16 % of the pain intensity and the functional repercussions variance (P<.01) and depersonalization accounting for 6 % of functional repercussions on mood and sociability variance. ConclusionsThis research confirms the role of beliefs in the development and maintenance of chronic low-back pain. Following the development of the fear-avoidance model and the many studies based on this conception, the study of fear-avoidance beliefs can’t be dissociated from the study of catastrophism. It is now widely accepted that catastrophism lead to the development of fear-avoidance beliefs related to pain, which in turn lead to the development of physical deconditioning and psychological distress. Because work-relted fear-avoidance beliefs have a high predictive value and are higher among workers with a lower latitude of decision, we put these findings in relation to the concept of perceived injustice. This research also highlights the fact that burnout would be a risk factor for increased pain and disability. Frequently associated with various somatic symptoms, burnout results from an inability to cope to chronic stressful situations. Such exposure to stress adversely affects physical health. The increase of emotional exhaustion over time can cause muscle tension resulting in loss of strength and muscular mobility, causing musculoskeletal disorders. Ultimately, this research shows that taking into account work-related interpersonal dimensions is necessary in order to improve the understanding of this complex phenomenon of chronic pain.