Behavioral Symptom Clusters, Inflammation, and Quality of Life in Chronic Low Back Pain

Background: Chronic low back pain is a prevalent condition, often involving an inflammatory process. Behavioral symptoms, including depressed mood, fatigue, and sleep disturbance, intensifies pain and reduces quality of life. Aims: The objectives of this pilot study were to identify behavioral symptom clusters (depressive mood, fatigue, poor sleep) in individuals with chronic low back pain, and to determine whether there are differences in pain, quality of life and inflammation (plasma IL-6) based on cluster membership. Design and Settings: A cross-sectional study was conducted in a pain clinic. Participants/ Subjects: Participants between ages 21 to 70 years (N1/469) were enrolled if they had chronic low back pain for at least six months. Methods: Participants completed instruments measuring, pain, depressive mood, fatigue, sleep, and demographic form. Blood (10ml) was obtained. Latent class analysis was used to identify clusters. Results and Conclusions: Findings revealed a two-class model, with Class 1 characterized by more depressive mood, fatigue, and sleep disturbance compared to Class 2. Class 1 participants reported worse quality of life than those in Class 2. Pain severity and pain interference were not significantly different between the classes. Levels of IL-6 were significantly greater in Class 1 participants compared to Class 2 with higher levels of IL-6 correlating with greater pain severity and sleep disturbances. Logistic regression revealed higher levels of IL-6 predicted Class 1 membership. Behavioral symptoms cluster exist in chronic low back pain patients and impact quality of life. Inflammation may contribute to relationship between behavioral symptoms and pain severity. (c) 2020 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Automated summary

The study aimed to identify behavioral symptom clusters in individuals with chronic low back pain and found a two-class model, with one class experiencing more severe depressive mood, fatigue, and sleep disturbance, leading to worse quality of life. Pain severity and interference were not significantly different across classes. Levels of IL-6 were significantly higher in the class with more severe behavioral symptoms, correlating with greater pain severity and sleep disturbances.