Comparative Associations of Working Memory and Pain Catastrophizing With Chronic Low Back Pain Intensity

Corey B Simon; Trevor A Lentz; Mark D Bishop; Joseph L Riley 3rd; Roger B Fillingim; Steven Z George

doi:10.2522/ptj.20150335

Comparative Associations of Working Memory and Pain Catastrophizing With Chronic Low Back Pain Intensity

Phys Ther. 2016 Jul;96(7):1049-56. doi: 10.2522/ptj.20150335. Epub 2015 Dec 23.

Authors

Corey B Simon¹, Trevor A Lentz², Mark D Bishop³, Joseph L Riley 3rd⁴, Roger B Fillingim⁵, Steven Z George⁶

Affiliations

¹ C.B. Simon, DPT, PhD, Department of Physical Therapy, College of Public Health & Health Professions, University of Florida; Pain Research and Intervention Center of Excellence, University of Florida, 2004 Mowry Rd, PO Box 100242, Gainesville, FL 32610 (USA); and Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida. csimon@dental.ufl.edu.
² T.A. Lentz, PT, Department of Physical Therapy, College of Public Health & Health Professions, University of Florida, and Pain Research and Intervention Center of Excellence, University of Florida.
³ M.D. Bishop, PT, PhD, Department of Physical Therapy, College of Public Health & Health Professions, University of Florida, and Pain Research and Intervention Center of Excellence, University of Florida.
⁴ J.L. Riley III, PhD, Pain Research and Intervention Center of Excellence, University of Florida, and Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida.
⁵ R.B. Fillingim, PhD, Pain Research and Intervention Center of Excellence, University of Florida, and Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida.
⁶ S.Z. George, PT, PhD, Department of Physical Therapy, College of Public Health & Health Professions, University of Florida, and Pain Research and Intervention Center of Excellence, University of Florida.

Abstract

Background: Because of its high global burden, determining biopsychosocial influences of chronic low back pain (CLBP) is a research priority. Psychological factors such as pain catastrophizing are well established. However, cognitive factors such as working memory warrant further investigation to be clinically useful.

Objective: The purpose of this study was to determine how working memory and pain catastrophizing are associated with CLBP measures of daily pain intensity and movement-evoked pain intensity.

Design: This study was a cross-sectional analysis of individuals with ≥3 months of CLBP (n=60) compared with pain-free controls (n=30).

Method: Participants completed measures of working memory, pain catastrophizing, and daily pain intensity. Movement-evoked pain intensity was assessed using the Back Performance Scale. Outcome measures were compared between individuals with CLBP and those who were pain-free using nonparametric testing. Associations were determined using multivariate regression analyses.

Results: Participants with CLBP (mean age=47.7 years, 68% female) had lower working memory performance (P=.008) and higher pain catastrophizing (P<.001) compared with pain-free controls (mean age=47.6 years, 63% female). For individuals with CLBP, only working memory remained associated with daily pain intensity (R(2)=.07, standardized beta=-.308, P=.041) and movement-evoked pain intensity (R(2)=.14, standardized beta=-.502, P=.001) after accounting for age, sex, education, and interactions between pain catastrophizing and working memory.

Limitations: The cross-sectional design prevented prospective analysis. Findings also are not indicative of overall working memory (eg, spatial) or cognitive performance.

Conclusion: Working memory demonstrated the strongest association with daily pain and movement-evoked pain intensity compared with (and after accounting for) established CLBP factors. Future research will elucidate the prognostic value of working memory on prevention and recovery of CLBP.

Publication types

Comparative Study

MeSH terms

Adult
Case-Control Studies
Catastrophization / psychology*
Chronic Pain / etiology
Chronic Pain / psychology*
Cross-Sectional Studies
Female
Humans
Low Back Pain / etiology
Low Back Pain / psychology*
Male
Memory, Short-Term*
Middle Aged
Movement*
Pain Measurement

Abstract

Publication types

MeSH terms

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