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How does pain lead to disability? A systematic review and meta-analysis of mediation studies in people with back and neck pain
Open accessAbstract
Disability is an important outcome from a clinical and public health perspective. However, it is unclear how disability develops in people with low back pain or neck pain. More specifically, the mechanisms by which pain leads to disability are not well understood. Mediation analysis is a way of investigating these mechanisms by examining the extent to which an intermediate variable explains the effect of an exposure on an outcome. This systematic review and meta-analysis aimed to identify and examine the extent to which putative mediators explain the effect of pain on disability in people with low back pain or neck pain. Five electronic databases were searched. We found 12 studies (N = 2961) that examined how pain leads to disability with mediation analysis. Standardized regression coefficients (β) of the indirect and total paths were pooled. We found evidence to show that self-efficacy (β = 0.23, 95% confidence interval [CI] = 0.10 to 0.34), psychological distress (β = 0.10, 95% CI = 0.01 to 0.18), and fear (β = 0.08, 95% CI = 0.01 to 0.14) mediated the relationship between pain and disability, but catastrophizing did not (β = 0.07, 95% CI = -0.06 to 0.19). The methodological quality of these studies was low, and we highlight potential areas for development. Nonetheless, the results suggest that there are significant mediating effects of self-efficacy, psychological distress, and fear, which underpins the direct targeting of these constructs in treatment.
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“It is well-documented that, compared to White individuals, Black individuals demonstrate increased pain sensitivity.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [218]
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“Black individuals have reported higher levels of pain for clinical conditions such as AIDS, glaucoma, arthritis, post-operative pain, post-spinal fusion pain, and low back pain 216–220.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [218]
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“For example, among people who seek care for chronic musculoskeletal pain, those with coexisting depression and/or anxiety report worse pain, greater physical impairment, increased postoperative opioid use, and a lower rate of return to work than those without depression and anxiety [8-11].”
From A Digital Mental Health Intervention in an Orthopedic Setting for Patients With Symptoms of Depression and/or Anxiety: Feasibility Prospective Cohort Study (2022) · cites this paper as [10]
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Self-citation
Metadata
- Authors
- Lee, H., Hübscher, M., Moseley, G. L., Kamper, S. J., Traeger, A. C., Mansell, G., & McAuley, J. H.
- Affiliations
- The University of Sydney (AU)
- UNSW Sydney (AU)
- University of South Australia (AU)
- Arthritis Research UK (GB)
- Corresponding author
- McAuley, James H.
- ORCID
- Venue
- Pain
- Published
- 2015-06
- Volume
- 156
- Issue
- 6
- Pages
- 988-997
- ISSN
- 0304-3959 (ISSN-L)
- OpenAlex
- W2007701602
- Cited by
- 526
- References
- 82
- Citations by year
- 2026: 41 · 2025: 43 · 2024: 61 · 2023: 67 · 2022: 68 · 2021: 57 · 2020: 51 · 2019: 40 · 2018: 38 · 2017: 27 · 2016: 25 · 2015: 6
- FWCI
- 4.01
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amsterdamumc.nl
- Licence
- other-oa
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Keele Research Repository (Keele University) (submittedVersion, cc-by)
- Aston Publications Explorer (Aston University) (submittedVersion)
- VU Research Portal (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- McGill University
- Australian Institute of Sport
- Medical Research Council
- National Health and Medical Research Council (1061279)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- disability, low back pain, neck pain, mediation analysis, self-efficacy, psychological distress, fear, pain catastrophizing
- MeSH terms
- Back Pain, Persons with Disabilities, Humans, Databases, Factual, Disease Progression, Neck Pain
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