Abstract
Purpose of the study and background
In the majority of low back pain (LBP) patients a definitive cause for back pain cannot be established; consequently, many patients report feeling uncertain about their diagnosis. They also experience pain-related guilt, which can be divided into: social guilt, managing pain guilt and verification of pain guilt. This study aimed to test a theoretical (causal) model, which proposed that diagnostic uncertainty leads to pain-related guilt, which leads to depression, anxiety and finally to disability.
Summary of the methods used and the results
Structural equation modelling was employed to test this model on 438 participants with LBP. The model demonstrated an adequate to good fit with the data. Diagnostic uncertainty predicts all three types of guilt. Verification of pain guilt predicts disability, managing pain guilt predicts anxiety, while social guilt was the strongest predictor of negative outcomes, predicting depression, anxiety and disability.
Conclusion
These preliminary findings demonstrate that diagnostic uncertainty and pain-related guilt are predictors of outcomes in LBP. They are important in relation to at least two aspects: firstly, psychological interventions produce small to moderate and mostly short term effects. This could be due to poorly designed and inconsistent theoretical models, which do not consider subcomponents of overarching psychological constructs such as depression. Secondly, they use heterogeneous groups of patients. Our model examined guilt, a known symptom of clinical depression but poorly understood within the context of pain. It also classified LBP participants according to their diagnosis-related beliefs. This should enable a greater understanding of how LBP patients differ and could help adjust consultations, reassurance given and treatment accordingly.
This abstract reports preliminary findings of a study that has not been submitted or published in another journal or meeting.
Conflicts of interest: No conflicts of interest
Source of Funding: The study was partly funded by the Pain Relief Foundation and British College of Osteopathic Medicine; however they had no involvement in the study design, data collection, data analysis and manuscript preparation.
