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Association of Pain and Depression in Those With Chronic Low Back Pain: The Mediation Effect of Patient Sexual Functioning

Pakpour, Amir H. PhD*,†; Nikoobakht, Mehdi MD; Campbell, Paul PhD§

doi: 10.1097/AJP.0000000000000076
Original Articles

Objectives: One theoretical model suggests that the pathway from pain to depression is through the 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.

Materials and Methods: This was a cross-sectional study on consecutive patients attending a chronic pain management clinic in Iran. All measures (pain intensity, depressive symptoms, sex-specific sexual function) were obtained by a self-report questionnaire, completed by patients while 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: A total of 742 patients (351 men, 391 women) took part in this study. Both the male and female mediation models showed a significant association between pain intensity and depressive symptoms, and both the models were significantly mediated by sexual functioning (P<0.001). Effect size calculations show a medium to large effect on male patients (κ2 0.23; 95% CI, 0.15-0.39) and a medium effect for female patients (κ2 0.16; 95% CI, 0.06-0.28). Both the 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 and general pain management.

*Social Determinants of Health Research Centre

Department of Public Health

Department of Neurosurgery, Qazvin University of Medical Sciences, Qazvin, Iran

§Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK

The authors declare no conflict of interest.

Reprints: Paul Campbell, PhD, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom (e-mail: p.campbell@keele.ac.uk).

Received October 16, 2013

Received in revised form February 25, 2014

Accepted January 15, 2014

© 2015 by Lippincott Williams & Wilkins