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Genetics and the environment affect the relationship between depression and low back pain

a co-twin control study of Spanish twins

Pinheiro, Marina B.a,*; Ferreira, Manuela L.b; Refshauge, Kathryna; Colodro-Conde, Lucíac,d; Carrillo, Eduvigisc; Hopper, John L.e; Ordoñana, Juan R.c; Ferreira, Paulo H.a

doi: 10.1097/01.j.pain.0000460330.56256.25
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Although the co-occurrence of low back pain (LBP) and depression is common, the nature of this association remains unclear. We aimed to investigate whether symptoms of depression are associated with LBP after adjusting for various confounders, including genetics. We used cross-sectional data from 2148 twins from the Murcia Twin Registry, Spain. All twins answered questions about lifetime prevalence of LBP (outcome variable) and symptoms of depression, collected through two instruments, deriving 3 measures: (1) self-report feelings of depression and anxiety; (2) state depression, and (3) trait depression. First, associations were investigated using logistic regression analysis of the total sample. We performed subsequent matched within-pair twin case–control analyses with all complete twin pairs discordant for LBP regardless of zygosity, and separately for dizygotic and monozygotic pairs. This sequential analysis allows for more precise estimates of the relationship between variables, as in each step, the impact of early shared environment and genetics is further considered. Symptoms of depression and anxiety were associated with higher prevalence of LBP in the total sample analysis (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.31-2.05), and this relationship was stronger in the subsequent case–control analysis (OR, 1.74; 95% CI, 1.13-2.69) and dizygotic case–control analysis (OR, 2.39; 95% CI, 1.39-4.08) but disappeared when the analysis was conducted for monozygotic twins (OR, 0.92; 95% CI, 0.42-2.05). A similar pattern was found for state and trait depression. The depression–LBP relationship disappears when high levels of control for confounding factors are applied and seems to be driven by genetic or environmental factors that influence both conditions.

The association between depression and low back pain is confounded by genetic and environmental factors that influence both conditions.

aArthritis & Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, Australia

bMusculoskeletal Division, The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia

cMurcia Twin Registry, Department of Human Anatomy and Psychobiology, University of Murcia and IMIB-Arrixaca, Murcia, Spain

dDepartment of Quantitative Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia

eCentre for Epidemiology & Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia

Corresponding author. Address: Faculty of Health Sciences, The University of Sydney, 75 East St, Lidcombe, Sydney, NSW 1825, Australia. Tel.: +61 2 9351 9010; fax: +61 2 9351 9601. E-mail address: mdeb9852@uni.sydney.edu.au (M. B. Pinheiro).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received August 13, 2014

Received in revised form November 25, 2014

Accepted December 04, 2014

© 2015 International Association for the Study of Pain
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