The Relationship Between Pain Catastrophizing, Kinesiophobia, Central Sensitization, and Cognitive Function in Patients With Chronic Low Back Pain

OBJECTIVES: Adverse pain behaviors and alterations in cognitive performance are shown to negatively impact the management of chronic low back pain (CLBP). Relationships between these variables are poorly recognized yet may impact the efficacy of interventions that target them. This study aimed to investigate the relationship between levels of pain catastrophizing (PC), kinesiophobia, central sensitization (CS), and cognitive performance in participants with CLBP. METHODS: A sample of 60 participants aged 18 to 65 with CLBP completed pain behavior measures (Pain Catastrophizing Scale [PCS], Tampa Scale of Kinesiophobia [TSK], and the Central Sensitization Inventory [CSI]) and cognitive performance tests (Stroop Color Word Test [SCWT], Comprehensive Trail Making Test-Second Edition [CTMT2], and the Coding test). RESULTS: SCWT performance was positively correlated with PCS and TSK, whereas CTMT2 inhibitory control and set-shifting, as well as coding performance, were each negatively correlated with PCS and TSK. The high PC group demonstrated significantly larger attentional interference times on the SCWT, poorer inhibitory control and set-shifting performance on the CTMT2, and lesser performance on the coding test than the low PC group. The high kinesiophobia group performed significantly poorer on the SCWT than the low kinesiophobia group. DISCUSSION: This study demonstrates that PC and kinesiophobia have negative influences on cognitive performance in those with CLBP. Specifically, attentional interference, inhibitory control, set-shifting, and sustained working memory functions were affected. These deficits have the potential to influence how patients respond to therapeutic interventions with a cognitive focus (eg, pain neuroscience education, cognitive-behavioral therapy) and highlight an important variable that should be considered when managing CLBP.