Exploring Interactions between Sex, Pain Characteristics, Disability, and Quality of Life in People with Chronic Spinal Pain: A Structural Equation Model

In people with nonspecific chronic spinal pain (nCSP), disability, and quality of life are associated with clinical, cognitive, psychophysical, and demographic variables. However, evidence regarding the interactions between these variables is only limited for this population. Therefore, this study aims to explore path models explaining the multivariate contributions of such variables to disability and quality of life in people with nCSP. This secondary analysis uses baseline data from a randomized controlled trial including 120 participants with nCSP. Structural equation modeling was used to explore path models for the Pain Disability Index (PDI), the Short Form 36-item physical (SF-36 PC), and mental (SF-36 MC) component scores. All models included sex, pain catastrophizing, kinesiophobia, hypervigilance, and pain intensity. Additionally, the PDI and SF-36 PC models included pressure pain thresholds at the dominant pain site (i.e., neck or low back). Significant associations were found between sex, pain cognitions, pain intensity, and pressure pain thresholds. Only pain catastrophizing significantly directly influenced the PDI (p≤0.001) and SF-36 MC (p=0.014), while the direct effects on the SF-36 PC from kinesiophobia (p=0.008) and pain intensity (p=0.006) were also significant. However, only the combined effect of all pain cognitions on the SF-36 PC was mediated by pain intensity (p=0.019). Our findings indicate that patients’ pain-related cognitions have an adverse effect on their physical health-related quality of life via a negative influence on their pain intensity in people with nCSP. Perspective This secondary analysis details a network analysis confirming significant interactions between sex, pain cognitions, pain intensity, and pressure pain thresholds in relation to disability and health-related quality of life in people with chronic spinal pain. Moreover, its findings establish the importance of pain cognitions and pain intensity for these outcomes.