Sense of Control Over Health Impacts Outcomes in Patients With Low Back Pain

Laura Joszt

Patients who feel they have little control over their health are more likely to report being depressed as a result of pain they experience. Targeting a patient’s sense of control can improve outcomes and remove barriers to recovery for patients with pain.
 
In a study published in Journal of Pain Research, researchers sought to better understand the effect that perception of control an individual has over his or her health has on development of depression in patients with low back pain (LBP). This study is the first of its kind.
 
“Depression can be a significant barrier to recovery leading to increased disability; however, little is known on how depression develops,” the authors explained.
 
LBP is a common condition, with the proportion of the population that has been affected at some point varying from 40% to 80%. The authors noted that people who experience pain often also develop depression, which can be a barrier to recovery. Thus, depression should be a target for psychosocial pain management.
 
The researchers identified 2 components of perception of health: Internality, which is a measure of how much a person’s health is attributed to a consequence of their behaviors, and Externality, which measures how much a person attributes their health to external influences.
 
The study consisted of 637 participants who had previously participated in 2 other studies of primary care patients. Depressive symptoms were quantified using the Hospital Anxiety and Depression Scale-Depression, and the predictor variables within the model were pain intensity and pain interference related to LBP.
 
The results of the study partially supported the hypothesis that people with low Internality and high Externality were more likely to report an association between pain and depressive symptoms.
 
The study’s findings suggest that a person’s sense of control over their health could be used as an important prognostic factor to predict poor outcomes and that clinical strategies can be used to target negative beliefs in patients with LBP.
 
“We found that people who have a low sense of control over their health reported more depression and that depression did associate with disability,” the authors wrote. “This study helps to understand the link between pain, depression, and disability in those with LBP.”
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