Objectives: One theoretical model suggests a pathway from pain to depression is through disruption of social and relationship function. This study sought to test this hypothesis by considering the mediating effect of sexual functioning on the association between pain intensity and depressive symptoms in sexually active patients with chronic low back pain.
Methods: This was a cross sectional study of consecutive patients attending a chronic pain management clinic in Iran. All measures (pain intensity, depressive symptoms, gender specific sexual function) were obtained via a self-report questionnaire, completed by patients whilst attending the clinic. Sobel testing, including bias corrected bootstrapping was used to produce 95% confidence intervals (95%CI) to test the mediating effect of sexual function.
Results: In total 742 patients (351 males, 391 females) took part. Both male and female mediation models showed a significant association between pain intensity and depressive symptoms and both models were significantly mediated by sexual functioning (P<0.001). Effect size calculations show a medium to large effect on males (k2 0.23, 95% CI 0.15 to 0.39) and a medium effect for females (k2 0.16, 95%CI 0.06 to 0.28). Both models accounted for over 50% of the variance in depressive symptoms (model R2).
Discussion: This study has shown that sexual functioning significantly mediates the relationship between pain intensity and depressive symptoms in sexually active patients with chronic low back pain. Clinicians may wish to consider the assessment of sexual functioning within this patient group, and align treatments that address sexual dysfunction as well as general pain management.
(C) 2014 by Lippincott Williams & Wilkins