Ho-Joong Kim (Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, South Korea) and others report in The Spine Journal that women with lumbar spinal stenosis are more prone to pain catastrophising than men with the condition and this may explain why women report higher levels of back pain and disability than men in this patient population.
Kim et al explain that pain catastrophising is “an exaggerated negative orientation to anticipated or actual pain and has been associated with important pain-related outcomes, including greater pain intensity, pain chronicity, and anxiety.” They add that previous studies have indicated that women with osteoarthritis may experience higher levels of pain than men because are they are more likely to respond to pain by catastrophising. The authors also note that little is known about the association between pain catastrophising and pain/disability in patients with lumbar stenosis or whether pain catastrophising could explain the gender differences in pain/disability in this patient population (women report greater symptom severity). “The purpose of this study was, firstly, to determine whether catastrophising is associated with an increased intensity of pain and disability and secondly to determine whether catastrophising is linked to the relationship of gender to pain and disability in patients with degenerative lumbar spinal stenosis,” Kim et al write.
In a review of medical records of 95 patients with lumbar spinal stenosis (35 male; 60 female), they found that Visual Analogue Scale (VAS) scores for back pain and Oswestry Disability Index (ODI) scores were significantly higher in women than in men. Additionally, women had significantly higher Pain Catastrophising Scale (PCS) helplessness, magnification, rumination, and total PCS scores than men. For example, total PCS score was 27.85 in women vs. 19.94 in men (p=0.003).
Kim et al report: “Pain catastrophising, measured by PCS-helplessness, magnification, rumination, and total PCS, demonstrated a significant positive association with pain intensity and disability represented by VAS for back pain/leg pain and ODI scores.” They add that the direct effect of gender on both VAS for back pain and on ODI became insignificant after controlling for PCS. “These findings suggest women experience higher levels of back and leg pain and are more disabled than men because women have a higher level of catastrophising than men,” the authors write.
According to Kim et al, the reasons for gender differences in pain catastrophising are unclear. They state that the possible reasons include social learning forces leading to “gender-typed traits” or that catastrophising is more “situationally determined under the environment that foster or inhibit catastrophic thinking”.
The authors conclude: “The results of the current study support the future need for intervention to reduce catastrophic thinking, with the goal of increasing treatment efficacy for lumbar spinal stenosis.”
Speaking to Spinal News International, corresponding author Jin S Yeom and lead author Ho-Joong Kim say, “Catastrophising has come to light as a key determinant for pain and disability associated with chronic pain disease. We discovered that this also applied to spinal stenosis in the study. Furthermore, recent reports have shown catastrophic thinking can be not only a prognostic factor, but also a moderating factor of outcomes of conservative treatment for relieving pain and improving disability in patients with low back pain (1-3). Therefore, behaviour treatment including graded exposure and graded activity can decrease catastrophic thinking, which results in decrease of back pain in patients with chronic low back pain (4). Therefore, conservative treatment and simultaneous behaviour treatment will work for relief of symptoms, especially in high catastrophising patients with lumbar spinal stenosis.”
They add, “Interestingly, our recent work regarding the association between surgical outcomes and preoperative catastrophising demonstrated that there was no difference of surgical outcome 12 months after surgery between high catastrophising and low catastrophising patients with spinal stenosis, whereas there was significant difference of surgical outcomes at three and six months after surgery between both groups.”
1 Wertli MM, Eugster R, Held U, Steurer J, Kofmehl R, Weiser S. Catastrophizing-a prognostic factor for outcome in patients with low back pain: a systematic review. Spine J 2014.
2. Wertli MM, Burgstaller JM, Weiser S, Steurer J, Kofmehl R, Held U. Influence of catastrophizing on treatment outcome in patients with nonspecific low back pain: a systematic review. Spine (Phila Pa 1976). 2014; 39:263-73.
3. Beneciuk JM, Robinson ME, George SZ. Low back pain subgroups using fear-avoidance model measures: results of a cluster analysis. Clin J Pain 2012; 28:658-66.
4. George SZ, Zeppieri G, Jr, Cere AL, Cere MR, Borut MS, Hodges MJ, Reed DM, Valencia C, Robinson ME. A randomized trial of behavioral physical therapy interventions for acute and sub-acute low back pain (NCT00373867). Pain 2008; 140:145-57.