Chronic low back pain is common in the population and is responsible for a significant number of sick leaves. It becomes a real public health issue. Indeed, the pain associated with chronic low back pain impacts patients’ functional ability, particularly their ability to carry out professional activities. That is why the research is involved in understanding the physiological and psychological aspects of this pain. Researchers show that some risk factors, such as anxiety or catastrophism, affect how the patient adapts to his state of health. The patient’s perceptions of his illness also play a part in reducing, maintaining or increasing pain and functional disability. Through these perceptions, the individual implements adapted behaviours and manages the symptoms of his illness with a view to acquiring a state of equilibrium, both physical and psychological (Albert, Coutu, & Durand, 2012). Several perceptions of the illness are highlighted by Leventhal (2003) in the common sense model of self-regulation of health and disease. On the one hand, there are negative emotions linked to the disease and, on the other hand, there are cognitions, constituted of beliefs related to five dimensions: identity, cause, consequences, temporality and perceived control (Leventhal & Brissette, 2003; Albert, Coutu, & Durand, 2012). As each person has her own perceptions of her state of health, there are inter-individual differences in the meaning given to it. Depending on the functional or dysfunctional nature of these perceptions, the relation with pain can differ and lead to disability.
Nevertheless, few studies focus on the influence of endogenous and stable psychological processes, whether cognitive (intolerance to uncertainty, somatosensory amplification, etc.) or emotional (emotional regulation), on perceptions of the disease and ultimately on pain and disability. This study aims to understand if these psychological processes are related to the dimensions of illness perceptions and to functional ability. The final objective is to identify cognitive and emotional vulnerability profiles to improve the management of patients with chronic low back pain.
A quantitative methodology provides answers to this issue. Five online questionnaires (Oswestry Disability Index; DERS-f SF; Somatosensory Amplification Scale; Uncertainty Intolerance Scale; Illness perception questionnaire adapted for work disability) are administrated to patients who are on sick leave due to chronic low back pain and included in the rehabilitation protocol in the CHU of Angers.
First of all, the whole of statistical analyses show that in this sample, the participants present a severe functional handicap, particularly in the social sphere, in sitting positions and carrying heavy loads. The symptoms of this disease are invisible, which can lead to a lack of recognition of pain by the social and professional entourage, and a feeling of loss of the social role. Nevertheless, psychological processes are not significantly correlated with functional disability, which differs from current research in which having difficulty regulating emotions, being intolerant of uncertainty and amplifying somatic and sensory feelings tend to increase pain. Moreover, we observe that psychological processes are involved in contrasting ways in perceptions. Difficulties of emotional regulation are linked to the emotional perception of the state of health, its consequences and its coherence. This profile of emotional vulnerability is particularly distinguished in view of the results. The more a patient has difficulties of emotional regulation, the more he has a negative emotional perception of his illness, the less coherent the meaning he gives to it, and finally, the more disability he develops. Satisfactory emotional regulation could act as a protective factor by maintaining a coherent sense of the disease and reducing its emotional impact. The cognitive processes of somatosensory amplification and of intolerance to uncertainty do not allow us to draw up complete vulnerability profiles, although somatosensory amplification is related to some perceptions. The more a patient has a tendency to amplify his somatic and sensory sensations, the more he represents the cyclical nature of his state of health. As for intolerance to uncertainty, it is not significantly correlated to the dimensions of the perceptions of the disease, whereas the duration of pain symptoms, treatments and their effectiveness are likely to trigger uncertainty.
There are a few limitations that may affect the validity and scope of the results, including a small sample size which did not allow all statistical analyses to be executed and which questions the representativeness of the target population. The psychological state of the patients during the first confinement, the length of questionnaires and the use of tools more generic than specific may also have affected the scope of the results. However, this study opens research possibilities, implementing for example other psychological processes with a more participants, and clinical possibilities, by specific management of the psychological processes to reduce their impact on the perceptions.
Keywords: chronic low back pain, illness perception, intolerance of uncertainty, emotional regulation, somatosensory amplification
Words I have learned:
- to carry out: effectuer
- a rehabilitation: une rééducation
- to implement: mettre en œuvre
- a sick leave: un arrêt de travail
- due to [something]: en raison de, à cause de
- the whole of: l’ensemble de
- a sample: un échantillon
- the scope: la portée
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