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Comparative Associations of Working Memory and Pain Catastrophizing With Chronic Low Back Pain Intensity
Corey B Simon1, Trevor A Lentz2, Mark D Bishop3
1C.B. Simon, DPT, PhD, Department of Physical Therapy, College of Public Health & Health Professions, University of Florida; Pain Research and Intervention Center of Excellence, University of Florida, 2004 Mowry Rd, PO Box 100242, Gainesville, FL 32610 (USA); and Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida. csimon@dental.ufl.edu.
Background:
Because of its high global burden, determining biopsychosocial influences of chronic low back pain (CLBP) is a research priority. Psychological factors such as pain catastrophizing are well established. However, cognitive factors such as working memory warrant further investigation to be clinically useful.
Objective:
The purpose of this study was to determine how working memory and pain catastrophizing are associated with CLBP measures of daily pain intensity and movement-evoked pain intensity.
Design:
This study was a cross-sectional analysis of individuals with ≥3 months of CLBP (n=60) compared with pain-free controls (n=30).
Method:
Participants completed measures of working memory, pain catastrophizing, and daily pain intensity. Movement-evoked pain intensity was assessed using the Back Performance Scale. Outcome measures were compared between individuals with CLBP and those who were pain-free using nonparametric testing. Associations were determined using multivariate regression analyses.
Results:
Participants with CLBP (mean age=47.7 years, 68% female) had lower working memory performance (P=.008) and higher pain catastrophizing (P<.001) compared with pain-free controls (mean age=47.6 years, 63% female). For individuals with CLBP, only working memory remained associated with daily pain intensity (R(2)=.07, standardized beta=-.308, P=.041) and movement-evoked pain intensity (R(2)=.14, standardized beta=-.502, P=.001) after accounting for age, sex, education, and interactions between pain catastrophizing and working memory.
Limitations:
The cross-sectional design prevented prospective analysis. Findings also are not indicative of overall working memory (eg, spatial) or cognitive performance.
Conclusion:
Working memory demonstrated the strongest association with daily pain and movement-evoked pain intensity compared with (and after accounting for) established CLBP factors. Future research will elucidate the prognostic value of working memory on prevention and recovery of CLBP.
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