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      Psychological factors: anxiety, depression, and somatization symptoms in low back pain patients

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          Abstract

          Aim

          To determine the prevalence of low back pain (LBP), investigate the sociodemographic characteristics of patients with LBP, and examine its association with psychological distress such as anxiety, depression, and somatization.

          Subjects and methods

          Of the 2742 patients approached, 2180 agreed to participate in this cross-sectional study (79.5% response rate). The survey was conducted among primary health care visitors from March to October 2012 and collected sociodemographic details and LBP characteristics. General Health Questionnaire-12 was used to identify the probable cases. Anxiety was assessed with Generalized Anxiety Disorder-7, depression was assessed with Patient Health Questionnaire-9, and somatization was measured with Patient Health Questionnaire-15.

          Results

          The study sample consisted of 52.9% males and 47.1% females. The prevalence of LBP was 59.2%, comprising 46.1% men and 53.9% women. LBP was significantly higher in Qataris (57.9%), women (53.9%), housewives (40.1%), and individuals with higher monthly income (53.9%). Somatization (14.9%) was observed more in LBP patients, followed by depression (13.7%) and anxiety disorders (9.5%). The most frequently reported symptoms were “headaches” (41.1%) and “pain in your arms, legs, or joints” (38.5%) in LBP patients with somatization. The most frequent symptoms among depressed LBP patients were “thinking of suicide or wanting to hurt yourself” (51.4%) and “feeling down, depressed, or hopeless” (49.2%). “Not being able to stop or control worrying” (40.2%), “worrying too much about different things” (40.2%), and “feeling afraid as if something awful might happen” (40.2%) were the most common anxiety symptoms in LBP patients. Psychological distress such as anxiety (9.5% versus 6.2%), depression (13.7% versus 8.5%), and somatization (14.9% versus 8.3%) were significantly higher in LBP patients.

          Conclusion

          The prevalence of LBP in this study sample was comparable with other studies. Furthermore, psychological distress such as anxiety, depression, and somatization were more prevalent in LBP patients compared to patients without LBP.

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          Most cited references 34

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          The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults.

          Population-based, cross-sectional, mailed survey. To determine the lifetime, 6-month period, and point prevalence of low back pain and its related disability among Saskatchewan adults and to investigate the presence and strength of selective response bias. There have been many reports of the prevalence of low back pain in different populations, and the estimates vary widely depending on case definition. However, most studies fail to differentiate between trivial and disabling back pain, which raises the issue of the usefulness of these estimates. No studies have yet documented the prevalence of graded low back pain severity and its related disability in a North American, general, population-based survey. The Saskatchewan Health and Back Pain Survey was mailed to a probability sample of 2184 Saskatchewan adults between 20 and 69 years of age. Fifty-five percent of the eligible population responded to the survey. Respondents were compared with nonrespondents, and the presence of selective response bias by back pain status was investigated by wave analysis. The point and lifetime prevalence of low back pain was determined by simple questions, and the 6-month period prevalence of low back pain was determined by the Chronic Pain Questionnaire. All estimates were age standardized to the Saskatchewan population. The authors estimate that at the time of the survey 28.4% (95% confidence interval, 25.6-31.1) of the Saskatchewan adult population were experiencing low back pain, and 84.1% (95% confidence interval, 81.9-86.3) had experienced it during their lifetime. Overall, 48.9% (95% confidence interval, 45.9-52.0) of the population had experienced low intensity/low-disability low back pain in the previous 6 months, 12.3% (95% confidence interval, 10.3-14.4) had experienced high-intensity/low-disability low back pain, and an additional 10.7% (95% confidence interval, 8.8-12.5) had experienced high-disability low back pain in the previous 6 months. There was little variation in the estimates over age groups, but women experienced more high-disability back pain than men. There was no evidence of selective response bias by low back pain status in the survey. Low-intensity/low-disability low back pain is a common problem in the general population. Approximately 11% of the adult population studied had been disabled by low back pain in the previous 6 months.
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            Low back pain in Australian adults: prevalence and associated disability.

            To determine the prevalence ranges of low back pain (LBP) together with any related disability in Australian adults. A population-based survey. The survey was mailed in June 2001 to a stratified random sample of 3000 Australian adults selected from the Electoral Roll. Demographic variables of respondents were compared with the Australian population. Selective response bias was investigated using wave analysis. A range of prevalence data was derived, as were disability scores using the Chronic Pain Grade. There was a 69% response rate. There was little variation between the sample and the Australian adult population. There was no significant selective response bias found. The sample point prevalence was estimated at 25.6% (95% confidence interval [CI], 23.6-27.5), 12-month prevalence was 67.6% (95% CI, 65.5-69.7), and lifetime prevalence was 79.2%, (95% CI, 77.3-81.0). In the previous 6-month period, 42.6% (95% CI, 40.4-44.8) of the adult population had experienced low-intensity pain and low disability from it. Another 10.9% (95% CI, 9.6-12.3) had experienced high intensity-pain but still low disability from this pain. However, 10.5% (95% CI, 9.2-11.9) had experienced high-disability LBP. LBP is a common problem in the Australian adult population, yet most of this is low-intensity and low-disability pain. Nevertheless, over 10% had been significantly disabled by LBP in the past 6 months. Data from this study will provide a better understanding of the magnitude of the LBP problem in Australia, the need for access to health care resources, and also strategic research directions.
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              The back pain revolution

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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2013
                04 February 2013
                : 6
                : 95-101
                Affiliations
                [1 ]Department of Medical Statistics and Epidemiology, Hamad Medical Corporation, Doha, Qatar
                [2 ]Department of Public Health, Weill Cornell Medical College, Doha, Qatar
                [3 ]Department of Evidence for Population Health Unit, School of Epidemiology and Health Sciences, The University of Manchester, Manchester, UK
                [4 ]Department of Medical Education, Weill Cornell Medical College, Doha, Qatar
                [5 ]Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
                Author notes
                Correspondence: Abdulbari Bener, Department of Medical Statistics and Epidemiology, Hamad Medical Corporation, PO Box 3050, Doha, Qatar, Tel +974 4439 3765; +974 4439 3766, Fax +974 4439 3769, Email abener@ 123456hmc.org.qa ; abb2007@ 123456qatar-med.cornell.edu
                Article
                jpr-6-095
                10.2147/JPR.S40740
                3569050
                © 2013 Bener et al, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                Categories
                Original Research

                Anesthesiology & Pain management

                somatization, anxiety, depression, low back pain, primary health care

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