A comparison of anatomical pain sites from a tertiary care sample: Evidence of disconnect between functional and perceived disability specific to lower back pain

Heterogeneity has been identified within chronic musculoskeletal pain (CMP) patient samples; however, investigations have typically focused on psychological constructs or coping (e. g., pain-related anxiety, catastrophizing) in this regard. Furthermore, studies to date have included either samples presenting with a specific anatomical site (e. g., only lower back pain) or a mix of anatomical sites (e. g., lower back, shoulder, or leg pain) as the primary pain complaint, without making comparisons based on the anatomical site of reported pain. For example, patients with chronic lower back pain (CLBP) may differ from those with chronic upper or lower extremity pain (ULEP) in presentation, recovery trajectory, and psychological variables. The current investigation explored whether systematic differences existed between patients participating in a multidisciplinary reconditioning third-party-payer program who have CLBP relative to patients with ULEP. Patients included those with CLBP (n = 23; 35% women) or ULEP (e. g., arm, shoulder, leg, knee; n = 28; 29% women). The ULEP group began and finished the program with more pain-related anxiety, more catastrophic thoughts, and more fearful cognitions than the CLBP group. There were no significant correlations between functional deficit and perceived levels of disability or associations between group and return to work status; however, there was an unexpected significant interaction between group and perceived disability. Specifically, CLBP patients reported increasing perceived disability despite improvements in functional deficit, whereas ULEP patients did not. These findings suggest a disconnect between perceived disability and function that may be specific to lower back pain. Implications and directions for future research are discussed. (C) 2009 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.