title: The significance of pain catastrophizing in clinical manifestations of patients with lumbar spinal stenosis: mediation analysis with bootstrapping.
abstract: BACKGROUND
  Pain intensity in various chronic pain disorders has been associated with catastrophizing. Considering the pathomechanism and clinical symptoms of lumbar spinal stenosis (LSS), pain catastrophizing could be associated with pain intensity and disability in patients with LSS.
  
  
  OBJECTIVE
  Firstly, to determine whether catastrophizing is associated with an increased intensity of pain and disability, and secondly, to determine whether it is linked to the relationship of gender to pain and disability in patients with degenerative LSS by using mediation analyses with bootstrapping.
  
  
  METHODS
  Medical records review.
  
  
  METHODS
  Patients with degenerative LSS were included.
  
  
  METHODS
  They included visual analog scale (VAS) for back pain, VAS for leg pain, Oswestry Disability Index (ODI), and pain catastrophizing scale (PCS).
  
  
  METHODS
  Ninety-five patients who were diagnosed with degenerative LSS were included in this study. Detailed demographic data including age, sex, and body mass index and series of questionnaires were collected, including PCS, ODI, and VAS for back and leg pain. Radiologic analysis including the grade of canal stenosis and disc/facet joint degeneration was performed using magnetic resonance imaging and computed tomography findings. After adjustment of covariates, multivariate regression analysis was used to assess each component of the proposed mediation models among VAS for back/leg pain, ODI, gender, and PCS. Mediation was also assessed by the bootstrapping technique.
  
  
  RESULTS
  Pain catastrophizing demonstrated a significant positive association with pain intensity and disability represented by VAS for back and leg pain and ODI scores. The mediation analysis confirmed the mediating role of VAS for back pain in the relationship between PCS and ODI. Furthermore, multivariate regression analysis with bootstrapping demonstrated that the PCS significantly mediated the gender differences in VAS for back pain and ODI.
  
  
  CONCLUSIONS
  Pain catastrophizing was a mediator of gender differences for back pain and disability in patients with LSS. In addition, pain catastrophizing was associated with disability in LSS, which was partially mediated by increased back pain intensity.
authors.affiliation: Spine Center, Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 110-744, Republic of Korea; Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam 463-707, Republic of Korea.
authors.forename: Ho-Joong
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Spine Center, Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 110-744, Republic of Korea; Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam 463-707, Republic of Korea.
authors.forename: Chan-Hee
authors.initials: CH
authors.lastname: Cho
authors.affiliation: Department of Mechanical Engineering, Yonsei University, 134 Shinchon-dong, Seodaemun-gu, Seoul, Republic of Korea.
authors.forename: Kyoung-Tak
authors.initials: KT
authors.lastname: Kang
authors.affiliation: Spine Center, Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 110-744, Republic of Korea; Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Republic of Korea.
authors.forename: Bong-Soon
authors.initials: BS
authors.lastname: Chang
authors.affiliation: Spine Center, Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 110-744, Republic of Korea; Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Republic of Korea.
authors.forename: Choon-Ki
authors.initials: CK
authors.lastname: Lee
authors.affiliation: Spine Center, Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 110-744, Republic of Korea; Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam 463-707, Republic of Korea. Electronic address: highcervical@gmail.com.
authors.forename: Jin S
authors.initials: JS
authors.lastname: Yeom
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D058443:Catastrophization / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012737:Sex Factors; D013130:Spinal Stenosis / Q000150:complications / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Bootstrapping; Gender difference; Lumbar spinal stenosis; Oswestry disability index; Pain catastrophizing; Pain catastrophizing scale