Chronic low back pain and the risk of depression or anxiety symptoms: insights from a longitudinal twin study
Abstract
Background context Pain is commonly associated with symptoms of depression or anxiety, although this relationship is considered bidirectional. There is limited knowledge regarding causal relationships.Purpose This study aims to investigate whether chronic low back pain (LBP) increases the risk of depression or anxiety symptoms, after adjusting for shared familial factors.Study design This is a longitudinal, genetically informative study design from the Murcia Twin Registry in Spain.Patient sample The patient sample included 1,269 adult twins with a mean age of 53 years.Outcome measures The outcome of depression or anxiety symptoms was evaluated with EuroQol questionnaire.Methods Using logistic regression analyses, twins were initially assessed as individuals in the total sample analysis, followed by a co-twin case-control, which was partially (dizygotic [DZ] twins) and fully (monozygotic [MZ] twins) adjusted for shared familial factors. There was no external funding for this study and no conflict of interest was declared.Results There was a significant association between chronic LBP and the risk of depression or anxiety symptoms in the unadjusted total sample analysis (odds ratio [OR]: 1.81, 95% confidence interval [CI]: 1.34-2.44). After adjusting for confounders, the association remained significant (OR: 1.43, 95% CI: 1.05-1.95), although the adjusted co-twin case-control was non-significant in DZ (OR: 1.03, 95% CI: 0.50-2.13) and MZ twins (OR: 1.86, 95% CI: 0.63-5.51).Conclusions The relationship between chronic LBP and the future development of depression or anxiety symptoms is not causal. The relationship is likely to be explained by confounding from shared familial factors, given the non-statistically significant associations in the co-twin case-control analyses.
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Chronic pain commonly coexists with depression and anxiety, and these conditions are bidirectional risk factors for one another.
“Chronic pain commonly coexists with depression and anxiety, and these conditions are bidirectional risk factors for one another [1-5].”
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- Authors
- Fernandez, M., Colodro-Conde, L., Hartvigsen, J., Ferreira, M. L., Refshauge, K. M., Pinheiro, M. B., Ordoñana, J. R., & Ferreira, P. H.
- Affiliations
- University of Southern Denmark (DK)
- The University of Sydney (AU)
- Instituto Murciano de Investigación Biosanitaria (ES)
- ORCID
- Venue
- The Spine Journal
- Publisher
- Elsevier BV
- Published
- 2017-07
- Volume
- 17
- Issue
- 7
- Pages
- 905-912
- ISSN
- 1529-9430 (ISSN-L)
- OpenAlex
- W2594911017
- Cited by
- 115
- References
- 53
- Citations by year
- 2026: 11 · 2025: 7 · 2024: 19 · 2023: 13 · 2022: 19 · 2021: 12 · 2020: 14 · 2019: 7 · 2018: 7 · 2017: 5 · 2016: 1
- FWCI
- 6.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Spine Journal (publishedVersion)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
- Funders
- Chiropractic and Osteopathic College of Australasia (COCA) Research Limited
- Fundación Séneca, Regional Agency for Science and Technology (08633/PHCS/08, 15302/PHCS/10, 19151/PD/13)
- Ministry of Science and Innovation (PSI2009-11560, PSI-2014-56680-R)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Keywords
- chronic low back pain, depression, anxiety symptoms, bidirectional relationship, co-twin control, monozygotic twins, dizygotic twins, genetic epidemiology, confounding
- MeSH terms
- Adult, Depression, Female, Humans, Male, Middle Aged, Twins, Dizygotic, Twins, Monozygotic, Low Back Pain
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