Depression and suicidal ideation in high-performance athletes suffering from low back pain: The role of stress and pain-related thought suppression.

BACKGROUND: Depression and suicidal ideation are important health problems in athletes suffering from pain. Dysfunctional pain cognitions, that is, pain-related thought suppression (PTS), may play an important role in their aetiology. Thought suppression was shown to increase depressive mood, particularly in highly stressed individuals. This cross-sectional study examines the relationship between PTS and stress on depression and suicidal ideation in athletes with pain. METHODS: A total of 159 athletes with non-specific low back pain completed a set of questionnaires to measure PTS, depression and stress. Participants were split into groups with high and low stress, and high and low PTS. Two-way ANOVA calculated main effects for PTS, stress and a PTS*stress interaction, with depressive symptoms as dependent. Subsequently, distribution tests were calculated, investigating if the presence of clinically relevant depression and suicidal ideation is dependent of conditions of high/low PTS and stress. RESULTS: A main effect of stress demonstrated higher depression scores in highly stressed athletes. Further, a significant PTS*stress interaction showed elevated depression scores in athletes with high PTS and high stress. Distribution analysis revealed positive associations between PTS, stress and depression, with depression being most frequent among athletes with high PTS and high stress. Suicidal ideation was not significantly associated with PTS and only weakly correlated with stress. CONCLUSIONS: Our findings show that PTS is the most common pain response in athletes with pain. The results indicate a higher prevalence of depression and elevated depressive symptoms in athletes experiencing high stress, seemingly more pronounced when highly engaging in PTS. SIGNIFICANCE: This study contributes to the understanding of depression in athletes with pain, suggesting stress and pain-related thought suppression to increase symptoms and prevalence of depression. As athletes often experience acute or chronic pain, understanding the impact of pain cognitions on health outcomes is an important step in the optimization of treatments.

Recovery-stress patterns and low back pain: Differences in pain intensity and disability.

BACKGROUND: Recovery describes a restoring process influencing the health conditions of individuals but a potential link to low back pain (LBP) has not been scrutinized so far. Psychological strategies to deal with LBP have been considered within the biopsychosocial approach but substantial evidence regarding specific psychological underpinnings remains elusive. The current study aimed to compare individuals with different recovery-stress patterns (i.e. specific combinations of recovery/stress) regarding their pain and disability in the lower back. METHODS: Cross-sectional data from 265 physically active individuals with non-specific LBP were collected via standardized questionnaires. The participants engaged in prescribed exercise therapy provided by a healthcare professional owing to their back burden. A k-means cluster analysis identified three clusters. RESULTS: Cluster 1 entailed individuals with high recovery and low stress values, Cluster 2 represented participants with medium scores on both dimensions and Cluster 3 included participants with low recovery and high stress values. The statistical analyses for pain intensity using analyses of covariance indicated significantly higher values for Cluster 3 compared with Clusters 1 and 2 for worst pain intensity (p < 0.001 and p = 0.003, respectively) and mean pain intensity (p < 0.001 and p = 0.001, respectively). The disability comparisons using non-parametric tests showed significantly higher LBP-related disability in Cluster 3 than Cluster 1 on two disability measures. CONCLUSIONS: The findings indicate an association between detrimental recovery-stress patterns and LBP. Examining the role of recovery has innovative practical relevance for LBP prevention and rehabilitation through the implementation of approaches to enhance recovery in relevant programmes.

Psychological detachment as moderator between psychosocial work conditions and low back pain development.

OBJECTIVES: Recovery processes in leisure time influence the effect of psychosocial work factors on health issues. However, this function of recovery has been neglected in research regarding the influence of work-related risk factors on low back pain (LBP) development. The aim of this prospective study was to examine the function of psychological detachment - a relevant recovery experience - concerning the influence of psychosocial work factors on LBP development. A moderating function of detachment for the interplay of work factors and LBP was assumed. MATERIAL AND METHODS: Sixty pain-free administrative employees of German universities completed an online survey 3 times during a 6-month period. Generalized estimating equations were used to estimate risk-factors of LBP. RESULTS: Analyses revealed an increased chance of LBP development for smokers and a decreasing chance when work resources were high. Detachment had no direct influence on LBP development, although it moderated the influence of work stressors and work resources on LBP. On the one hand, high detachment values seem to protect against an increased chance of LBP development when employees were confronted with high work stressors, while on the other hand high detachment values enhance the protective effect of high work resources. CONCLUSIONS: The results indicated a moderating role of detachment concerning the influence of psychosocial work factors on LBP development. Therefore, it is necessary to include recovery processes in future research regarding LBP development and consequently in LBP prevention concepts. Int J Occup Med Environ Health 2017;30(2):313-327.

Differences in low back pain occurrence over a 6-month period between four recovery-stress groups.

BACKGROUND: Psychosocial work factors and general recovery experiences are hypothesised to influence the risk of low back pain (LBP) occurrence by influencing the acute recovery-stress state. So far, however, direct links between the acute recovery-stress state and LBP occurrence have not been investigated in detail. OBJECTIVE: The aim of this study was to investigate differences in low back pain occurrence between four distinct recovery-stress groups over a period of 6 month. METHODS: A prospective cohort study with a 3-month and 6-month follow-up measurement was conducted in a sample of administrative employees (N = 271). First, the sample was divided into four distinct recovery-stress groups by cluster analysis. Subsequently, differences in LBP occurrence between these four groups and the Relative Risk (RR) were analysed. RESULTS: Overall, groups with higher stress than recovery scores showed a higher risk of LBP occurrence compared to those groups with lower stress than recovery scores. Furthermore, the group with the highest stress and lowest recovery scores showed a significant higher proportion of LBP occurrence after six months than the group with the lowest stress and highest recovery scores (RR = 7.29). CONCLUSION: The results indicate the relevance of the acute recovery-stress state for LBP occurrence.

Exercise motivation and nonspecific back pain: A comparison of patients and nonpatients.

OBJECTIVE: Motivation is a key variable to consider during exercise or exercise therapy of individuals with back pain. Based on organismic integration theory, this study aims to improve the understanding of exercise motivation in patients and nonpatients by evaluating the relationships between typical motivational profiles and personal characteristics, therapy parameters and pain related variables. METHOD: One hundred nine women and 145 men with back pain (mean age 33.3 years; 31.9% currently under the care of a physician) involved in some kind of exercise for current nonspecific back pain voluntarily participated in this study. An adapted version of the Behavioral Regulation in Sport Questionnaire was used to measure exercise motivation. Furthermore, data on pain, disability status, level of sport activity, body concept, and the type of treatment or exercise were gathered. RESULTS: Autonomous forms of regulation were most prevalent among subjects. Of 4 motivational profiles found, 2 showed a positive pattern (29.1% highly motivated individuals, 21.7% autonomously convinced individuals), and 2 showed a more negative pattern (19.7% controlled convinced individuals, 29.5% less motivated individuals). Relationships between profiles and age, body concept, involvement in sport competition, and type of exercise were found. CONCLUSIONS: The different motivational profiles respectively reveal specific practical relevance. In particular, the controlled convinced pattern is supposed to be more maladaptive than all other profiles. The insights provided by this study supports the development of motivation-oriented treatments based on the assessment of individuals' motivational profiles. (PsycINFO Database Record

Parameters of low back pain chronicity among athletes: Associations with physical and mental stress.

OBJECTIVE: In the general population, physical and mental stress factors are linked to chronic low back pain (LBP). The aim of the present study was to examine this association among athletes. DESIGN: Longitudinal study with a six-month interval between measurements. SETTING: Questionnaires were filled out at home, either in paper-pencil version or online. PARTICIPANTS: Eighty-two male and 57 female athletes (N = 139, MAge = 32.24) who exercise on a competitive (n = 102) or recreational level (n = 37), with a weekly training volume of at least 3 h. MAIN OUTCOME MEASURES: At T0, stress parameters were assessed via the Recovery-Stress Questionnaire (RESTQ-Basic-48) and the Screening Scale of the Trier Inventory for the Assessment of Chronic Stress (TICS-SSCS). At T0 and T1, different chronification indicators were measured. Based on these assessments, the sample was split into a chronification and no-chronification group. RESULTS: ANCOVAs were used to conduct group comparisons with regard to stress levels. The chronification groups showed higher stress values for all chronification indicators. For the variables Physical Complaints and Overall Stress-TICS, the group differences became significant (p < .05). CONCLUSION: A relationship between stress parameters and LBP chronification was demonstrated among athletes for the first time.

The influences of recovery on low back pain development: A theoretical model.

Psychologically and physically straining work conditions increase the risk of low back pain (LBP) development. According to recent recovery theories, leisure time recovery can counteract the negative influences of work stress on health. Similarly, a recent empirical work has indicated a moderating role of recovery on the link between stress and health issues. In this paper, a theoretical model is deduced to integrate the moderating effects of recovery on work stress and LBP development. Based on theoretical and empirical results, 2 separate recovery paths are distinguished: on the one hand, recovery can prevent the experience of stress because a well-recovered person can cope more easily with work demands; while on the other hand, recovery refills the depleted resources after confrontation with work strain and reduces stress experiences. Given that work strains is a main risk factor for LBP development, recovery in leisure time seems to be a highly relevant aspect, which has not been investigated to date in the field of LBP.