title: Influence of educational attainment on pain intensity and disability in patients with lumbar spinal stenosis: mediation effect of pain catastrophizing.
abstract: METHODS
  Level IV, prospective case series.
  
  
  OBJECTIVE
  To investigate the influence of educational attainment on the level of pain intensity and disability in patients with lumbar spinal stenosis (LSS) and determine how coping behavior, such as catastrophizing, may mediate the association between educational attainment and clinical impairments.
  
  
  BACKGROUND
  Educational attainment has been thought to influence disability caused by chronic painful disease, mediated by pain behavior or a coping strategy such as catastrophizing. Nevertheless, little is known about the role of educational attainment on pain intensity or disability related with LSS.
  
  
  METHODS
  A total of 155 patients who were diagnosed as degenerative LSS participated in the study. Data on detailed medical history, physical examination, and series of questionnaires were collected, including pain catastrophizing scale, Oswestry Disability Index, and visual analogue pain scale for back and leg pain. For measures of socioeconomic status, educational attainment and occupation were assessed. Radiological analysis was performed using magnetic resonance images and computed tomographic scans. After adjustment of covariates, multivariate regression analysis was used to assess each component of the proposed mediation models among visual analogue pain scale for back/leg pain, Oswestry Disability Index, the level of education, occupation and pain catastrophizing scale. Mediation was also assessed by the bootstrapping technique.
  
  
  RESULTS
  Educational attainment was negatively correlated with pain intensity, disability, and catastrophizing. Pain catastrophizing were also significantly correlated with disability and pain intensity for back/leg pain in the patients with LSS. In the relationship among variables, the mediation analysis with bootstrapping clearly showed the role of catastrophizing in the mediation between visual analogue pain scale for back pain/leg pain, Oswestry Disability Index, and the level of education.
  
  
  CONCLUSIONS
  This study demonstrated that lower educational attainment was associated with increased pain intensity and disability in patients with LSS, which was mediated by the coping mechanism, catastrophizing.
authors: *Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sungnam, Republic of Korea †Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea; and ‡Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea.
authors: Ho-Joong
authors: HJ
authors: Kim
authors: Sung-Chan
authors: SC
authors: Kim
authors: Kyoung-Tak
authors: KT
authors: Kang
authors: Bong-Soon
authors: BS
authors: Chang
authors: Choon-Ki
authors: CK
authors: Lee
authors: Jin S
authors: JS
authors: Yeom
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D058443:Catastrophization / Q000503:physiopathology / Q000523:psychology*; D004185:Disability Evaluation; D006233:Persons with Disabilities; D004522:Educational Status; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology / Q000523:psychology*; D010147:Pain Measurement; D011446:Prospective Studies; D012720:Severity of Illness Index; D013130:Spinal Stenosis / Q000503:physiopathology / Q000523:psychology*; D011795:Surveys and Questionnaires