Exploring stress in low back pain : from patient perspectives to neurophysiology

Abstract

Musculoskeletal pain disorders (MDs) are common health problems and a leading cause of disability worldwide. Of these, low back pain (LBP) is the most common disorder, with a global prevalence of 23%, a figure expected to rise further in future. Persistent MDs, and in particular persistent LBP, occurring when pain lasts longer than three months, have a significant negative impact at physical, psychological, social and economic levels. Despite the magnitude of the problem, current treatments for persistent LBP have achieved limited success. One reason for the lack of effective treatments is a limited understanding of the complex experience of LBP that takes into account both the subjective experience of pain, as well as the neurophysiological mechanisms underpinning the development of this disorder. For this reason, prioritization of research into the individual experience of LBP in conjunction with the mechanisms of LBP is essential to reduce the burden of this condition at both the individual and societal levels. Psychosocial factors, particularly symptoms of depression and anxiety are widely accepted risk factors for the development and persistence of MDs, including LBP. However, these mood symptoms are often experienced alongside symptoms of agitation, irritability and tension, which characterize another less recognized emotional state termed "stress". Although closely related to symptoms of depression and anxiety, research on the role of stress in MDs, particularly non-work related stress, is scarce. Thus, the overall aim of this thesis was to contribute to the body of knowledge investigating the subjective experience and physiological impact of stress on individuals with LBP using a diverse range of research methodologies. In order to address this overarching aim, four research studies were conducted.

Date of Award	2018
Original language	English