Stress and Pain. Predictive (Neuro)Pattern Identification for Chronic Back Pain: A Longitudinal Observational Study
IntroductionLow back pain (LBP) leads to considerable impairment of quality of life worldwide and is often accompanied by psychosomatic symptoms.ObjectivesFirst, to assess the association between stress and chronic low back pain (CLBP) and its simultaneous appearance with fatigue and depression as a...
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Frontiers Media S.A.
2022-05-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.828954/full |
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| author | Pia-Maria Wippert Pia-Maria Wippert Laura Puerto Valencia David Drießlein |
| author_facet | Pia-Maria Wippert Pia-Maria Wippert Laura Puerto Valencia David Drießlein |
| author_sort | Pia-Maria Wippert |
| collection | DOAJ |
| description | IntroductionLow back pain (LBP) leads to considerable impairment of quality of life worldwide and is often accompanied by psychosomatic symptoms.ObjectivesFirst, to assess the association between stress and chronic low back pain (CLBP) and its simultaneous appearance with fatigue and depression as a symptom triad. Second, to identify the most predictive stress-related pattern set for CLBP for a 1-year diagnosis.MethodsIn a 1-year observational study with four measurement points, a total of 140 volunteers (aged 18–45 years with intermittent pain) were recruited. The primary outcomes were pain [characteristic pain intensity (CPI), subjective pain disability (DISS)], fatigue, and depressive mood. Stress was assessed as chronic stress, perceived stress, effort reward imbalance, life events, and physiological markers [allostatic load index (ALI), hair cortisol concentration (HCC)]. Multiple linear regression models and selection procedures for model shrinkage and variable selection (least absolute shrinkage and selection operator) were applied. Prediction accuracy was calculated by root mean squared error (RMSE) and receiver-operating characteristic curves.ResultsThere were 110 participants completed the baseline assessments (28.2 ± 7.5 years, 38.1% female), including HCC, and a further of 46 participants agreed to ALI laboratory measurements. Different stress types were associated with LBP, CLBP, fatigue, and depressive mood and its joint occurrence as a symptom triad at baseline; mainly social-related stress types were of relevance. Work-related stress, such as “excessive demands at work”[b = 0.51 (95%CI -0.23, 1.25), p = 0.18] played a role for upcoming chronic pain disability. “Social overload” [b = 0.45 (95%CI -0.06, 0.96), p = 0.080] and “over-commitment at work” [b = 0.28 (95%CI -0.39, 0.95), p = 0.42] were associated with an upcoming depressive mood within 1-year. Finally, seven psychometric (CPI: RMSE = 12.63; DISS: RMSE = 9.81) and five biomarkers (CPI: RMSE = 12.21; DISS: RMSE = 8.94) could be derived as the most predictive pattern set for a 1-year prediction of CLBP. The biomarker set showed an apparent area under the curve of 0.88 for CPI and 0.99 for DISS.ConclusionStress disrupts allostasis and favors the development of chronic pain, fatigue, and depression and the emergence of a “hypocortisolemic symptom triad,” whereby the social-related stressors play a significant role. For translational medicine, a predictive pattern set could be derived which enables to diagnose the individuals at higher risk for the upcoming pain disorders and can be used in practice. |
| first_indexed | 2024-04-13T09:08:44Z |
| format | Article |
| id | doaj.art-48e5950505244a65806fd0a62cb826d1 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-04-13T09:08:44Z |
| publishDate | 2022-05-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Medicine |
| spelling | doaj.art-48e5950505244a65806fd0a62cb826d12022-12-22T02:52:55ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-05-01910.3389/fmed.2022.828954828954Stress and Pain. Predictive (Neuro)Pattern Identification for Chronic Back Pain: A Longitudinal Observational StudyPia-Maria Wippert0Pia-Maria Wippert1Laura Puerto Valencia2David Drießlein3Medical Sociology and Psychobiology, University of Potsdam, Potsdam, GermanyFaculty of Health Sciences, Joint Faculty of the University of Potsdam, Brandenburg Medical School Theodor Fontane, and the Brandenburg University of Technology Cottbus-Senftenberg, Postdam, GermanyMedical Sociology and Psychobiology, University of Potsdam, Potsdam, GermanyStatistical Consulting Unit StaBLab, Ludwig-Maximilians-Universität München, Munich, GermanyIntroductionLow back pain (LBP) leads to considerable impairment of quality of life worldwide and is often accompanied by psychosomatic symptoms.ObjectivesFirst, to assess the association between stress and chronic low back pain (CLBP) and its simultaneous appearance with fatigue and depression as a symptom triad. Second, to identify the most predictive stress-related pattern set for CLBP for a 1-year diagnosis.MethodsIn a 1-year observational study with four measurement points, a total of 140 volunteers (aged 18–45 years with intermittent pain) were recruited. The primary outcomes were pain [characteristic pain intensity (CPI), subjective pain disability (DISS)], fatigue, and depressive mood. Stress was assessed as chronic stress, perceived stress, effort reward imbalance, life events, and physiological markers [allostatic load index (ALI), hair cortisol concentration (HCC)]. Multiple linear regression models and selection procedures for model shrinkage and variable selection (least absolute shrinkage and selection operator) were applied. Prediction accuracy was calculated by root mean squared error (RMSE) and receiver-operating characteristic curves.ResultsThere were 110 participants completed the baseline assessments (28.2 ± 7.5 years, 38.1% female), including HCC, and a further of 46 participants agreed to ALI laboratory measurements. Different stress types were associated with LBP, CLBP, fatigue, and depressive mood and its joint occurrence as a symptom triad at baseline; mainly social-related stress types were of relevance. Work-related stress, such as “excessive demands at work”[b = 0.51 (95%CI -0.23, 1.25), p = 0.18] played a role for upcoming chronic pain disability. “Social overload” [b = 0.45 (95%CI -0.06, 0.96), p = 0.080] and “over-commitment at work” [b = 0.28 (95%CI -0.39, 0.95), p = 0.42] were associated with an upcoming depressive mood within 1-year. Finally, seven psychometric (CPI: RMSE = 12.63; DISS: RMSE = 9.81) and five biomarkers (CPI: RMSE = 12.21; DISS: RMSE = 8.94) could be derived as the most predictive pattern set for a 1-year prediction of CLBP. The biomarker set showed an apparent area under the curve of 0.88 for CPI and 0.99 for DISS.ConclusionStress disrupts allostasis and favors the development of chronic pain, fatigue, and depression and the emergence of a “hypocortisolemic symptom triad,” whereby the social-related stressors play a significant role. For translational medicine, a predictive pattern set could be derived which enables to diagnose the individuals at higher risk for the upcoming pain disorders and can be used in practice.https://www.frontiersin.org/articles/10.3389/fmed.2022.828954/fullallostatic load indexhair cortisollow back painpsychosocial moderatorshypocortisolemic symptom triadstress types |
| spellingShingle | Pia-Maria Wippert Pia-Maria Wippert Laura Puerto Valencia David Drießlein Stress and Pain. Predictive (Neuro)Pattern Identification for Chronic Back Pain: A Longitudinal Observational Study Frontiers in Medicine allostatic load index hair cortisol low back pain psychosocial moderators hypocortisolemic symptom triad stress types |
| title | Stress and Pain. Predictive (Neuro)Pattern Identification for Chronic Back Pain: A Longitudinal Observational Study |
| title_full | Stress and Pain. Predictive (Neuro)Pattern Identification for Chronic Back Pain: A Longitudinal Observational Study |
| title_fullStr | Stress and Pain. Predictive (Neuro)Pattern Identification for Chronic Back Pain: A Longitudinal Observational Study |
| title_full_unstemmed | Stress and Pain. Predictive (Neuro)Pattern Identification for Chronic Back Pain: A Longitudinal Observational Study |
| title_short | Stress and Pain. Predictive (Neuro)Pattern Identification for Chronic Back Pain: A Longitudinal Observational Study |
| title_sort | stress and pain predictive neuro pattern identification for chronic back pain a longitudinal observational study |
| topic | allostatic load index hair cortisol low back pain psychosocial moderators hypocortisolemic symptom triad stress types |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.828954/full |
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