The Relationship between Pain Resilience and Back Pain Severity for Participants with Chronic Low Back Pain

Abstract

Most research for chronic pain is centered around psychosocial risk factors, like pathological vulnerability. Currently, researchers are looking at the potential protective role of positive and adaptive factors on chronic pain, like pain resiliency. However, it has not been well-established what role biobehavioral factors, like weight, or sociodemographic factors, like sex or race, may have on the multisystem dimensions of pain resilience, like behavioral perseverance and cognitive-affective positivity. The purpose of this study is to investigate the impact that these factors may have on the potential protective multiplexes of pain resilience in cLBP participants. We hypothesize that aspects of pain resilience, including behavioral perseverance and cognitive-affective positivity, will be associated with less cLBP severity and acute pain responses to QST testing. We further hypothesize that these associations will differ according to pain relevant sociodemographic factors such as ethnicity/race and sex/gender. A clinical trial study was conducted where 200 enrolled cLBP participants completed questionnaires on pain resilience and overall chronic pain and disability. To assess pain responses, participants completed quantitative sensory tests on multiple body sites, including the lower back. Overall, back pain severity was negatively associated with behavioral perseverance and pressure pain thresholds. Back pain severity was also positively associated with BPI severity and interference, temporal summation, and overall weight. Following identification of sex and racial differences, we examined the data by sex and race. It was revealed that these relationships were primarily driven by women and Caucasians, not men or African Americans. Lastly, overall weight was positively associated with temporal summation among all sex and racial groups. The relationship between behavioral perseverance and low back pain appears to be both sex and racially dependent. Weight may also play a critical role among this relationship and may have a direct effect on overall pain outcomes alone. This work was supported by the National Institutes of Health grant R01MD010441 to BRG.