Le modèle biopsychosocial dans la lombalgie commune chronique

Abstract

ObjectiveAs defined by the International Association for the Study of Pain, pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. The phenomenon is subjective and multifactorial (Affective-motivational and sensori-discriminative component). Chronic low back pain is a disability with significant socio-economic repercussions. To avoid such repercussions, the treatment of the low back pain requires global care taking into account all the factors involved, including those psychic. Any treatment based on pain alone would be insufficient. Our goal was to demonstrate the biopsychosocial model in low back pain. Material and methodThis is a cross-sectional study conducted on randomly recruited adult subjects regardless of low back pain. We studied anthropometric parameters, history of low back pain, endurance of spinal muscles, level of study, EVA low back pain and disability, antecedent and duration of low back pain, anxiety and depression. We used the Hospital Anxiety and Depression Scale, and the Arabic version of Quebec. We studied parameters in correlation and used the logistic regression of factors related to low back pain. ResultsOne hundred and twenty-five subjects were recruited, 89 were low back pain but 36 were not. The median age was 36 and 24 years, respectively. Lumbar pain was weakly correlated with duration of the evolution of pain (R=0.69), Sorensen (r=−0.45), Quebec (r=0.69), HAD (r=0.24) and anxiety (r=0.32), but correlated with depression in a non-significant way (r=0.069, p=0.49). In a single-variant analysis, HAD [OR=1.074, 95% CI (1.01–1.13)], age [OR=1.103, 95% CI (1.04–1.16)] and BMI [OR=1.340, 95% CI (1.15–1.54)] were the risk factors for low back pain (p=<0.01); university level and spinal endurance were identified as protective factors. Only spinal endurance [OR=0.97, 95% CI (0.95–0.99), p<0.01] and the university level [OR=0.76, 95% CI (0.58–0.98), p<0.041] remained significant in multivariate analysis. ConclusionMost studies show a reciprocal link between chronic pain and depression. Consequently, we must have been interested in the pain as in the psychic symptoms. We have the impression that is two mechanisms are involved. On the one hand, the patients express their psychic problems by pain as low back pain; on the other hand, pain triggers psychiatric processes. This causality has been well explained by the transactional stress model of Lazarus and Folkman. According to our results, protective factors such as level of study (university level) and the endurance of spinal muscles were the factors that would counteract risk factors such as psychic factors. The action on the beliefs and/or the cognition of the patients, whatever the level of culture, could constitute a therapeutic part, it is the cognitive therapy. By using non-medicated means like changing one's own behavior, the chronic pain patient can bring effective remedies against his or her condition. Although some patients are ignorant or have a low level of culture, action on information or sensitization could relieve patients. To improve the endurance of spinal muscles, we insist on the promotion of non-drug treatments by sensitization such as physical activity. Exercise can have specific benefits in reducing the severity of chronic pain, as well as improving overall physical and mental health and physical functioning. The final goal of our reflection is to insist, in these chronic pain patients, on a global multidisciplinary approach integrating physical, cognitive and behavioral therapies.