Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Mar;31(3):254-64.
doi: 10.1097/AJP.0000000000000108.

Psychological covariates of longitudinal changes in back-related disability in patients undergoing acupuncture

Felicity L Bishop  1 , Lucy Yardley, Philip Prescott, Cyrus Cooper, Paul Little, George T Lewith
Affiliations
Free PMC article

Psychological covariates of longitudinal changes in back-related disability in patients undergoing acupuncture

Felicity L Bishop et al. Clin J Pain. 2015 Mar.
Free PMC article

Abstract

Objectives: To identify psychological covariates of longitudinal changes in back-related disability in patients undergoing acupuncture.

Materials and methods: A longitudinal postal questionnaire study was conducted with data collection at baseline (pretreatment), 2 weeks, 3, and 6 months later. A total of 485 patients were recruited from 83 acupuncturists before commencing acupuncture for back pain. Questionnaires measured variables from 4 theories (fear-avoidance model, common-sense model, expectancy theory, social-cognitive theory), clinical and sociodemographic characteristics, and disability. Longitudinal multilevel models were constructed with disability over time as the outcome.

Results: Within individuals, reductions in disability (compared with the person's individual mean) were associated with reductions in: fear-avoidance beliefs about physical activity (β=0.11, P<0.01) and work (β=0.03, P<0.05), catastrophizing (β=0.28, P<0.05), consequences (β=0.28, P<0.01), concerns (β=0.17, P<0.05), emotions (β=0.16, P<0.05), and pain identity (β=0.43, P<0.01). Within-person reductions in disability were associated with increases in: personal control (β=-0.17, P<0.01), comprehension (β=-0.11, P<0.05) and self-efficacy for coping (β=-0.04, P<0.01). Between individuals, people who were less disabled had weaker fear-avoidance beliefs about physical activity (β=0.12, P<0.01), had more self-efficacy for coping (β=-0.07, P<0.01), perceived less severe consequences of back pain (β=0.87, P<0.01), had more positive outcome expectancies (β=-0.30, P<0.05), and appraised acupuncture appointments as less convenient (β=0.92, P<0.05).

Discussion: Illness perceptions and, to a lesser extent, self-efficacy and expectancies can usefully supplement variables from the fear-avoidance model in theorizing pain-related disability. Positive changes in patients' beliefs about back pain might underpin the large nonspecific effects of acupuncture seen in trials and could be targeted clinically.

PubMed Disclaimer

Conflict of interest statement

Supported by Arthritis Research UK (Career Development Fellowship 18099), Chesterfield, UK. G.T.L.’s post is supported by a grant from the Rufford Maurice Laing Foundation. The remaining authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram of participants through study. RMDQ indicates Roland Morris Disability Questionnaire.
See this image and copyright information in PMC

References

    1. Breivik H, Collett B, Ventafridda V, et al. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10:287–333. - PubMed
    1. Savigny P, Kuntze S, Watson P, et al. Low Back Pain. Early Management of Persistent Non-Specific Low Back Pain. NICE Clinical Guideline. 2009:88 edLondon: National Collaborating Centre for Primary Care and Royal College of General Practitioners; Available at: http://www.nice.org.uk/CG88. - PubMed
    1. MacPherson H, Sinclair-Lian N, Thomas K. Patients seeking care from acupuncture practitioners in the UK: a national survey. Complement Ther Med. 2006;14:20–30. - PubMed
    1. Brinkhaus B, Witt CM, Jena S, et al. Acupuncture in patients with chronic low back pain—a randomized controlled trial. Arch Intern Med. 2006;166:450–457. - PubMed
    1. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012;172:1444–1453. - PMC - PubMed

Publication types