Accepting low back pain: is it related to a good quality of life?

Whether individuals with chronic low back pain (CLBP) are willing to accept their pain, is of interest to pain management, but how far is the acceptance of pain related to a good quality of life (QoL)? Recently available measures now enable this question to be investigated; these are (1) the Chronic Pain Acceptance Questionnaire (CPAQ) and a revised version, here described as a short-form (SF-CPAQ), and (2) the World Health Organization Quality of Life Assessment (WHOQOL)-Pain, which is composed of the generic WHOQOL-100 profile (25 facets in 6 domains), and 4 additional facets within a specific pain and discomfort module (PDM).

Eighty-six CLBP outpatients (62.8% female, mean age 54.3 y, mean pain duration 69.4 mo) completed the CPAQ and WHOQOL-Pain, mailed 2 weeks before a pain clinic appointment.

General QoL was positively associated with overall acceptance of pain (CPAQ: r=0.376, P=0.003; SF-CPAQ: r=0.582, P<0.001), and with activity engagement (r=0.455, P<0.001) and pain willingness (r=0.493, P<0.001) specifically. Lower reports of pain were also associated with a better QoL (r=-0.349, P=0.002). Pain level was important in explaining QoL relating to the physical and social domains and pain-related facets assessed by the PDM. Overall, acceptance contributed to explain QoL in the level of independence and environment domains and for pain-related QoL assessed by the PDM. However, pain and acceptance only made a modest contribution to explaining psychologic and social dimensions of QoL.

The results indicate that present pain level and whether or not pain is accepted play an important role in the QoL of patients with chronic pain. Additionally, the results provide construct validity for the WHOQOL-Pain and SF-CPAQ measures, especially dimensions of pain willingness and activities engagement. The findings have implications for the way health care is delivered, particularly for the role of acceptance-based treatments for individuals with CLBP.