Cited by 149Musculoskeletal pain and rehabilitationSpine and Intervertebral Disc PathologyPain Management and Treatment

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Symptoms of depression and stress mediate the effect of pain on disability

Hall, Amanda M., Kamper, Steven J., Maher, Chris G., Latimer, Jane, Ferreira, Manuela L., Nicholas, Michael K.·2011·Pain

DOI 10.1016/j.pain.2011.01.014

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Abstract

The mechanism or mechanisms involved in the development of pain-related disability in people with low back pain is unclear. Psychological distress has been identified as one potential pathway by which an episode of pain influences the development of persistent disabling symptoms; however, the relationship has not been formally investigated. This study investigated the causal relationship between pain and disability via psychological distress (and its components depression, stress, and anxiety) by using mediation path analysis. The study sample included 231 participants with subacute low back pain (6 to 12 weeks' pain duration) who had been recruited for an exercise-based randomised, controlled trial. All participants completed self-report assessments of pain (0-10 numerical rating scale), disability (Roland Morris Disability Questionnaire), and psychological distress (Depression Anxiety and Stress Scale) at baseline and again at 2 follow-up time points (6 and 12 weeks after baseline). The results of the mediation analysis suggest that approximately 30% of the relationship between subacute pain and later disability is dependent on the level of patients' psychological distress. The finding that psychological distress only partially (30%) mediated the pain-disability relationship indicates that other factors should also be explored. Further analysis into the components of psychological distress revealed that the symptoms of depression and stress, but not anxiety, are responsible for mediation of the pain-disability relationship. These findings provide an opportunity to decrease the risk of long-term disability through early identification and management of depressive and stress symptoms.

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Authors: Hall, A. M., Kamper, S. J., Maher, C. G., Latimer, J., Ferreira, M. L., & Nicholas, M. K.
Affiliations: The University of Sydney (AU)
The George Institute for Global Health (AU)
Corresponding author: Hall, Amanda M.
ORCID: Hall, Amanda M.
Kamper, Steven J.
Latimer, Jane
Ferreira, Manuela L.
Nicholas, Michael K.
Venue: Pain
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2011-05
Volume: 152
Issue: 5
Pages: 1044-1051
ISSN: 0304-3959 (ISSN-L)
DOI: 10.1016/j.pain.2011.01.014
OpenAlex: W2052416153
Cited by: 149
References: 21
Citations by year: 2026: 8 · 2025: 7 · 2024: 9 · 2023: 12 · 2022: 11 · 2021: 6 · 2020: 10 · 2019: 7 · 2018: 8 · 2017: 6 · 2016: 10 · 2015: 12 · 2014: 14 · 2013: 15 · 2012: 10
FWCI: 10.07
Type: journal article
Language: en
Open access: closed
Locations: Pain (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Orthopedics and Sports Medicine › Spine and Intervertebral Disc Pathology
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords: low back pain, pain-related disability, depression, stress, anxiety, psychological distress, mediation, subacute pain, exercise therapy, long-term disability
MeSH terms: Depression, Disability Evaluation, Persons with Disabilities, Humans, Longitudinal Studies, Pain Measurement, Psychiatric Status Rating Scales, Surveys and Questionnaires, Regression Analysis, Stress, Psychological, Time Factors, Low Back Pain

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Symptoms of depression and stress mediate the effect of pain on disability

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