Psychosocial and behavioural characteristics in women with pregnancy-related lumbopelvic pain 12 years postpartum

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Abstract

Background

There is insufficient evidence regarding psychosocial factors and its long-term association with persistent pregnancy-related lumbopelvic pain. The overall aim of this study was to investigate women with persistent pregnancy-related lumbopelvic pain 12 years postpartum based on psychosocial and behavioural characteristics using the Swedish version of the Multidimensional Pain Inventory (MPI-S) classification system.

Material and methods

This is a cross-sectional study based on a previous cohort. Data collection took place through a questionnaire. A total of 295 women from the initial cohort ( n = 639) responded to the questionnaire giving a response rate of 47.3%. To determine the relative risk (RR) of reporting pain 12 years postpartum, a robust modified Poisson regression was used. This is the first study using the MPI-S as a predictive variable on women with persistent pregnancy-related lumbopelvic pain.

Results

The MPI-S classification procedure was carried out on a total of n = 226 women, where 53 women were classified as interpersonally distressed (ID), 82 as dysfunctional (DYS), and 91 as adaptive copers (AC). Women in the ID and DYS subgroups had a relative risk (RR) of reporting persistent pregnancy-related lumbopelvic pain 12 years postpartum that was more than twice as high compared to the AC subgroup (95% confidence interval (CI) in parenthesis): RR 2.57 (CI 1.76 - 3.75), p<0.0001 and RR 2.23 (CI 1.53 - 3.25), p<0.0001 respectively. Women in the DYS subgroup had more than 5 times increased risk of reporting sick leave the past 12 months compared to the AC subgroup (RR 5.44; CI 1.70 - 17.38, p=0.004).

Conclusions

The present study demonstrates that it is possible to classify women with persistent pregnancy-related lumbopelvic pain 12 years postpartum into relevant clinical subgroups based on psychosocial and behavioural characteristics using the MPI-S questionnaire.

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Most cited references 56

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A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain.

Tamar Pincus, A Burton, Steve Vogel … (2002)

A systematic review of prospective cohort studies in low back pain. To evaluate the evidence implicating psychological factors in the development of chronicity in low back pain. The biopsychosocial model is gaining acceptance in low back pain, and has provided a basis for screening measurements, guidelines and interventions; however, to date, the unique contribution of psychological factors in the transition from an acute presentation to chronicity has not been rigorously assessed. A systematic literature search was followed by the application of three sets of criteria to each study: methodologic quality, quality of measurement of psychological factors, and quality of statistical analysis. Two reviewers blindly coded each study, followed by independent assessment by a statistician. Studies were divided into three environments: primary care settings, pain clinics, and workplace. Twenty-five publications (18 cohorts) included psychological factors at baseline. Six of these met acceptability criteria for methodology, psychological measurement, and statistical analysis. Increased risk of chronicity (persisting symptoms and/or disability) from psychological distress/depressive mood and, to a lesser extent, somatization emerged as the main findings. Acceptable evidence generally was not found for other psychological factors, although weak support emerged for the role of catastrophizing as a coping strategy. Psychological factors (notably distress, depressive mood, and somatization) are implicated in the transition to chronic low back pain. The development and testing of clinical interventions specifically targeting these factors is indicated. In view of the importance attributed to other psychological factors (particularly coping strategies and fear avoidance) there is a need to clarify their role in back-related disability through rigorous prospective studies.

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The West Haven-Yale Multidimensional Pain Inventory (WHYMPI).

Robert D Kerns, Dennis C Turk, Thomas Rudy (1985)

The complexity of chronic pain has represented a major dilemma for clinical researchers interested in the reliable and valid assessment of the problem and the evaluation of treatment approaches. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI) was developed in order to fill a widely recognized void in the assessment of clinical pain. Assets of the inventory are its brevity and clarity, its foundation in contemporary psychological theory, its multidimensional focus, and its strong psychometric properties. Three parts of the inventory, comprised of 12 scales, examine the impact of pain on the patients' lives, the responses of others to the patients' communications of pain, and the extent to which patients participate in common daily activities. The instrument is recommended for use in conjunction with behavioral and psychophysiological assessment strategies in the evaluation of chronic pain patients in clinical settings. The utility of the WHYMPI in empirical investigations of chronic pain is also discussed.

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A review of psychological risk factors in back and neck pain.

S J Linton (2000)

The literature on psychological factors in neck and back pain was systematically searched and reviewed. To summarize current knowledge concerning the role of psychological variables in the etiology and development of neck and back pain. Recent conceptions of spinal pain, especially chronic back pain, have highlighted the role of psychological factors. Numerous studies subsequently have examined the effects of various psychological factors in neck and back pain. There is a need to review this material to ascertain what conclusions may be drawn. Medical and psychological databases and cross-referencing were used to locate 913 potentially relevant articles. A table of 37 studies was constructed, consisting only of studies with prospective designs to ensure quality. Each study was reviewed for the population studied, the psychological predictor variables, and the outcome. The available literature indicated a clear link between psychological variables and neck and back pain. The prospective studies indicated that psychological variables were related to the onset of pain, and to acute, subacute, and chronic pain. Stress, distress, or anxiety as well as mood and emotions, cognitive functioning, and pain behavior all were found to be significant factors. Personality factors produced mixed results. Although the level of evidence was low, abuse also was found to be a potentially significant factor. Psychological factors play a significant role not only in chronic pain, but also in the etiology of acute pain, particularly in the transition to chronic problems. Specific types of psychological variables emerge and may be important in distinct developmental time frames, also implying that assessment and intervention need to reflect these variables. Still, psychological factors account for only a portion of the variance, thereby highlighting the multidimensional view. Because the methodologic quality of the studies varied considerably, future research should focus on improving quality and addressing new questions such as the mechanism, the developmental time factor, and the relevance that these risk factors have for intervention.

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Author and article information

Contributors

Cecilia Bergström:

ORCID: http://orcid.org/0000-0003-0566-0457

+46703227573 , cecilia.bergstrom@umu.se

Margareta Persson: margareta.persson@umu.se

Ingrid Mogren: ingrid.mogren@umu.se

Journal

Journal ID (nlm-ta): Chiropr Man Therap

Journal ID (iso-abbrev): Chiropr Man Therap

Title: Chiropractic & Manual Therapies

Publisher: BioMed Central (London )

ISSN (Electronic): 2045-709X

Publication date (Electronic): 13 August 2019

Publication date PMC-release: 13 August 2019

Publication date Collection: 2019

Volume: 27

Electronic Location Identifier: 34

Affiliations

[1 ]ISNI 0000 0001 1034 3451, GRID grid.12650.30, Department of Clinical Sciences, Obstetrics and Gynecology, , Umeå University, ; 901 87 Umeå, Sweden

[2 ]ISNI 0000 0001 1034 3451, GRID grid.12650.30, Department of Nursing, , Umeå University, ; 901 87 Umeå, Sweden

Author information

Cecilia Bergström http://orcid.org/0000-0003-0566-0457

Article

Publisher ID: 257

DOI: 10.1186/s12998-019-0257-8

PMC ID: 6691525

SO-VID: 7a082f28-0abd-4048-a022-26edf2e5a81e

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 28 December 2018

Date accepted : 10 May 2019

Funding

Funded by: European Chiropractors Union

Award ID: A.13.04

Award Recipient : Cecilia Bergström

Funded by: FundRef http://dx.doi.org/10.13039/501100007508, Stiftelsen Sigurd and Elsa Goljes Minne;

Award ID: LA2016-0356

Award Recipient : Cecilia Bergström

Funded by: Västerbotten Läns Landsting (SE)

Funded by: FundRef http://dx.doi.org/10.13039/501100010794, Medicinska fakulteten, Umeå Universitet;

Award ID: Personal grant professorship

Award Recipient : Ingrid Mogren

Custom metadata

ScienceOpen disciplines: Complementary & Alternative medicine

Keywords: pregnancy-related lumbopelvic pain,postpartum,psychosocial characteristics,mpi,cross-sectional questionnaire study

Data availability:

ScienceOpen disciplines: Complementary & Alternative medicine

Keywords: pregnancy-related lumbopelvic pain, postpartum, psychosocial characteristics, mpi, cross-sectional questionnaire study

Psychosocial and behavioural characteristics in women with pregnancy-related lumbopelvic pain 12 years postpartum

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Abstract

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Material and methods

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The International Journal of Person Centered Medicine

Most cited references 56

A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain.

The West Haven-Yale Multidimensional Pain Inventory (WHYMPI).

A review of psychological risk factors in back and neck pain.

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