Relationship between low back pain and life-stressing events among Nigerian and Caucasian patients

Objectives Socio-economic status and life-stressing events have been shown to have ethnic and racial differences that exert a strong influence on care-seeking habits and recovery from low back pain (LBP). This study examined the relationship between life-stressing events and sensory and psychological attributes among Nigerian and Caucasian patients with LBP, and the influence of socio-economic status on this relationship. Design Stratified, single cohort questionnaire study. Setting Three outpatient physiotherapy clinics in Nigeria. Participants One hundred and sixty-five patients, including 107 Black Nigerians (age range 26-65 years, mean 52 years) and 58 Caucasians (age range 25-62 years, mean 41 years), with LBP of at least 6 weeks duration were recruited over a 9-year period. Main outcome measures The Low Back Pain Questionnaire, Social Re-adjustment Rating Scale, State-Trait Anxiety Inventory and Multiple Affect Adjective Check List. Socio-economic status and pain levels, on a 0-100 numerical rating scale, were also recorded. Questionnaires were administered within 5 days of the patient reporting at the clinic. Results Recorded pain intensity was similar in Nigerian [mean pain score 78, 95% confidence interval (CI) 73.4 to 83.4] and Caucasian (mean pain score 79, 95% CI 74.8 to 84.8) patients. Subjects who recorded higher numbers of life-stressing events on the Social Re-adjustment Rating Scale also recorded higher scores on a number of LBP attributes including hot, burning, bright, throbbing and pressure qualities. Pain intensity and state anxiety correlated significantly with life-stressing event scores among Caucasian patients, who were mainly of high socio-economic status. State and trait anxiety and emotional discomfort scores correlated significantly with life-stressing event scores among Nigerian patients, who were mainly of low to medium socio-economic status. Conclusion Most patients had experienced a number of life-stressing events, particularly those classified as being of low socio-economic status. Low socio-economic status patients who had experienced a high number of life-stressing events were more likely to show emotional and psychological symptoms, which may have influenced the reporting of the characteristics and history of their LBP. There is a need to assess these issues when managing LBP patients. Further research is required to determine how the outcome of treatment may be influenced by these factors. (C) 2007 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.