University of Oulu

Pinto SM, Cheung JPY, Samartzis D, Karppinen J, Zheng Y-p, Pang MYC and Wong AYL (2022) Are Morphometric and Biomechanical Characteristics of Lumbar Multifidus Related to Pain Intensity or Disability in People With Chronic Low Back Pain After Considering Psychological Factors or Insomnia? Front. Psychiatry 13:809891. doi: 10.3389/fpsyt.2022.809891

Are morphometric and biomechanical characteristics of lumbar multifidus related to pain intensity or disability in people with chronic low back pain after considering psychological factors or insomnia?

Saved in:
Author: Pinto, Sabina M.1; Cheung, Jason P. Y.2; Samartzis, Dino3,4;
Organizations: 1Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
2Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
3Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States
4International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, United States
5Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
6Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
7Finnish Institute of Occupational Health, Oulu, Finland
8Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.6 MB)
Persistent link:
Language: English
Published: Frontiers Media, 2022
Publish Date: 2022-09-16


Introduction: Lumbar multifidus muscle (LMM) dysfunction is thought to be related to pain and/or disability in people with chronic low back pain (CLBP). Although psychosocial factors play a major role in pain/disability, they are seldom considered as confounders in analyzing the association between LMM and CLBP.

Objectives: This study aimed to determine: (1) differences in psychological factors, insomnia, and LMM characteristics between people with and without CLBP; (2) associations between psychological factors, insomnia, or LMM characteristics and low back pain (LBP) intensity or LBP-related disability in people with CLBP; and (3) whether LMM characteristics are related to LBP symptoms in people with CLBP after considering confounders.

Methods: Seventy-eight volunteers with CLBP and 73 without CLBP provided sociodemographic information, filled the 11-point numeric pain rating scale and Roland-Morris disability questionnaire (RMDQ). They completed the Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS), Fear Avoidance Belief Questionnaire (FAB), and Insomnia Severity Index Scale (ISI). Resting and contracted thickness of LMM at L4-S1 levels were measured from brightness-mode ultrasound images. Percent thickness changes of LMM at L4-S1 levels during contraction were calculated. Resting LMM stiffness at L4-S1 was measured by shear wave elastography. Associations among LMM, psychosocial or insomnia parameters and clinical outcomes were analyzed by univariate and multivariate analyses.

Results: People with CLBP demonstrated significantly higher LBP-intensity, RMDQ, HADS, FAB, PCS, and ISI scores than asymptomatic controls (p < 0.05). The former also had significantly smaller percent thickness changes of LMM at L4/L5 during contraction. LBP-intensity was positively related to scores of PCS-total, PCS-helplessness, FAB-total, FAB-work, and ISI in people with CLBP (p < 0.05). RMDQ scores were positively associated with the scores of HADS-total, HADS-depression, PCS-total, FAB-total, FAB-physical activity, PCS-helplessness, and ISI in people with CLBP (p < 0.05). FAB-work and ISI scores together explained 24% of LBP-intensity. FAB-total scores alone explained 34% of variance of LBP-related disability in people with CLBP.

Conclusion: More fear-avoidance belief or insomnia is related to greater LBP-intensity and/or LBP-related disability in people with CLBP. Although people with CLBP were thought to have aberrant LMM morphometry/function, no LMM characteristics were related to LBP-intensity or LBP-related disability after considering other confounders.

see all

Series: Frontiers in psychiatry
ISSN: 1664-0640
ISSN-E: 1664-0640
ISSN-L: 1664-0640
Volume: 13
Article number: 809891
DOI: 10.3389/fpsyt.2022.809891
Type of Publication: A1 Journal article – refereed
Field of Science: 3124 Neurology and psychiatry
Funding: The current project was funded by the Early Career Scheme (251018/17M).
Copyright information: © 2022 Pinto, Cheung, Samartzis, Karppinen, Zheng, Pang and Wong. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.