title: The correlation between pain, catastrophizing, and disability in subacute and chronic low back pain: a study in the routine clinical practice of the Spanish National Health Service.
abstract: METHODS
  Correlation between variables measured with previously validated instruments.
  
  
  OBJECTIVE
  To explore the association between catastrophizing and disability in patients treated for subacute or chronic low back pain (LBP) within routine clinical practice in Spain.
  
  
  BACKGROUND
  The influence of psychological variables on LBP-related disability in Southern Europe is different to the one in the Anglo-Saxon and Northern European cultural environments. In Spanish LBP patients, the influence of fear avoidance beliefs on disability is negligible, and catastrophizing does not mediate the improvement of disability caused by active education. The association between catastrophizing and dis-ability is unknown.
  
  
  METHODS
  Thirty-three clinicians working for the Spanish National Health Service in 6 primary care and 8 specialty centers, recruited 1461 patients seeking care for subacute and chronic LBP. Patients were assessed only once. A linear regression model was developed to assess the percentage of the variance of disability explained by gender, age, chronicity status, severity of LBP, severity of referred pain (referred pain down to the leg), catastrophizing, eligible for workers' compensation (yes/no), failed back surgery (yes/no), radiologic findings, and treatments.
  
  
  RESULTS
  Correlations among LBP, referred pain down to the leg, disability, and catastrophizing were moderate, but significant. The strongest one was between disability and catastrophizing (r ∇ 0.520). Catastrophizing explained 28% of disability, whereas severity of LBP only 3%. Global adjusted R of the model was 0.387. There was an association between some radiologic findings and treatments, and slightly higher levels of disability.
  
  
  CONCLUSIONS
  In Southern European subacute and chronic LBP patients, catastrophizing correlates with dis-ability and explains approximately one-fourth of its variance. Further studies should assess its value as a prognostic factor in subacute and chronic patients.
authors.affiliation: Fundación Kovacs, Palma de Mallorca, Spain. kovacs@kovacs.org
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Kovacs
authors.forename: Jesús
authors.initials: J
authors.lastname: Seco
authors.forename: Ana
authors.initials: A
authors.lastname: Royuela
authors.forename: Andrés
authors.initials: A
authors.lastname: Peña
authors.forename: Alfonso
authors.initials: A
authors.lastname: Muriel
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D058443:Catastrophization / Q000209:etiology / Q000523:psychology*; D002908:Chronic Disease; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology*; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D016014:Linear Models; D017116:Low Back Pain / Q000150:complications / Q000523:psychology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data; D010146:Pain / Q000150:complications / Q000523:psychology; D059408:Pain Management; D013030:Spain; D011795:Surveys and Questionnaires; D014942:Workers' Compensation / Q000191:economics