# Exercise as it relates to Disease/Physical activity effect on mental health in people with chronic lower back pain

This wikibooks page is an analysis of the research article “Physical activity and the mediating effect of fear, depression, anxiety, and catastrophizing on pain related disability in people with chronic low back pain” by Paul W. M. Marshall, Siobhan Schabrun, Michael F. Knox (2017)

## Background

Chronic lower back pain (CLBP) is defined as pain affecting the lower lumber region of the spine and back which continues over 12 weeks. Individuals suffering from CLBP are not only faced with constant physical pain but their quality of life is affected as their ability to perform usual daily tasks is limited. Upholding a job and maintaining social relationships becomes harder resulting in additional burden of financial stress on the individual and their relationships with those around them. With limited evidence on treatment of chronic lower back pain there are few options to prescribe. Current treatment advised is designed to lessen the symptoms focusing on self-management of the disease An individual’s perception of the pain in CLBP is thought to have a detrimental effect on the pains severity. This study investigates catastrophic thinking creating fear and its effect on movement and disuse of the affected area. The role of regular physical activity in mediating the catastrophising and fear relationship is investigated with the study aiming to explore the fear-avoidance model which is used to explain the pain and disability association and address gaps in the literate surrounding variables of the model such as catastrophising and physical activity.

## Where is the research from?

This study was conducted at the school of Science and Health, Western Sydney University in NSW Australia lead by Paul W.M.Marhsall. Marhsall has been involved in and published multiple studies around the effects of Physical activity and rehabilitation The authors received no specific funding for their work and supplied all relevant data within the paper. What kind of research was this? The study is a cross-sectional study on individuals suffering from chronic lower back pain. Multiple mediation analysis were conducted with bias-correlated bootstrapping tests? to determine to role of Physical activity (PA) and mental health. All participants were individually interviewed with self-report questionnaires conducted during the interviews to obtain data including:
* Oswestry low back pain disability index (ODI) questionnaire measuring self-perceived disability
* FABQ-a and w, fear-avoidance beliefs questionnaire measuring participants beliefs on potential harm of work and PA on their back pain
* Pain catastrophising scale (PCS) looking at thoughts and feelings in relation to a painful experience
* Hospital Depression and Anxiety Scale (HADS-a and d) for indicating anxiety and depression

## What did the research involve?

This research involved a total of 218 people with chronic low back pain. Participants were aged between 18-65 years with a minimum of three months of lower back pain. Participants were not eligible if they; 1) had previously undergone surgery three months prior to the study and 2) had been pregnant within twelve months leading into the study. Information gathered from the interviews divided participants into two groups 1) those who reported performing regular structured physical activity once a week > 30 minutes, moderate intensity including self-directed structured exercise and leisure time activity or physical interventions prescribed by allied health professionals for current back pain. 2) those who reported not completing any physical activity.

## What were the basic results?

The study found that depression, fear and catastrophising mediated the relationship between pain and disability in lower back pain sufferers. Only the effects of catastrophizing, not depression and fear was conditional of regular weekly structured PA sessions. Those participating in regular activity required more support in terms of negative perception of pain distinguishing the differences of chronic pain and discomfort feel from normal physical movement. The effects of depression and fear on pain did not relate to regular PA. While PA interventions have numerous overall health benefits commonly prescribed for suffers with chronic back conditions the studies data suggests that more emphasis placed on correcting negative psychosocial components of pain may be more beneficial in order to achieve maximum results from physiological interventions Limitations within the study include accuracy of results as weekly physical activity was based on self-reported data. Type of exercise was not classified due to limited evidence supporting a superior exercise type prescribed for lower back pain.

## What conclusions can we take from this research?

The final results from the study indicate that while physical activity interventions have numerous overall health benefits and commonly prescribed for sufferers with chronic back conditions the study data suggests that more emphasis be placed on negative psychosocial components of pain. Prescribing psychological interventions may be more beneficial in order to achieve results from PA. Recommendations are made for those frequently engaging in physical activity suffering from CLBP suggesting more specific psychological counselling regarding their negative perceptions on pain1

## Practical advice

When an individual suffering from a chronic pain injury such as CLBP is resorted to self-management confidence in what they are doing and feeling within their body while performing exercise and any form of PA is critical in the effectiveness of interventions designed to manage conditions frequently into the future. More recent publications demonstrate similar results while exploring the multidimensional aspect of support for sufferers from their work place and health care providers while also highlighting the importance of communication between patient and professional recognising more therapy programs other than conventional biomedical and biomechanical rehabilitation
With any research used for the treatment of human beings, individual factors need to be considered and results should not be generalised for an entire population suffering from the same disease.With any research used for the treatment of human beings, individual factors need to be considered and results should not be generalised for an entire population suffering from the same disease.

## Further Information:

For further information regarding management and information on Chronic lower back pain, read below;
* Management of Lower Chronic Back Pain
* Multidisciplinary Pain Management
* Self-managing Chronic Pain PDF
* What is Back Pain

## References

* ↑ (1) https://www.mja.com.au/journal/2004/180/2/management-chronic-low-back-pain
* ↑ (2) https://www.westernsydney.edu.au/staff_profiles/uws_profiles/associate_professor_paul_marshall
* ↑ (3) Fairbank JC, Pynsent PB (2000) The Oswestry disability index. Spine 25: 2940–2953. PMID:11074683
* ↑ (4) Waddell G, Newton M, Henderson I, Somerville D, Main CJ (1993) A Fear-Avoidance Beliefs Questionnaire(FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 52:157–168. PMID: 8455963
* ↑ (5) Sullivan MJL, Bishop SR (1995) The pain catastrophizing scale: development and validation. Psychol Assessment 7: 524–532.
* ↑ (6) Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 52: 69–77. PMID: 11832252
* ↑ (7) Preacher KJ, Hayes AF (2008) Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Research Meth 40: 879–891.