Effect Of Chronic Low Back Pain And Exercise Intervention On Social Distance

Background Chronic low back pain(CLBP)is the most common chronic pain disease that results in serious harm to physiological,psychological,and social functions.While a large number of studies regarding CLBP mainly focus on pain,disability,and intervention measures,the effect of CLBP on social behavior and social distance regulation remains unclear.Furthermore,exercise therapy could effectively improve CLBP,alleviate pain,enhance physical function,and promote mental health.However,it is still unknown the effect of exercise on abnormal social distance.Purpose The study aimed to assess the social distance of patients with CLBP and healthy controls,explore the differences between the two groups;examine the correlation between social distance and pain,disability,anxiety,depression,social avoidance;and reveal the effect of exercise on social distance regulation in patients with CLBP.Methods Study 1,the cross-sectional study recruited 24 patients with CLBP and 24 healthy controls at Shanghai Orthopedic Hospital and Shanghai University of Sport,Shanghai,China.A social distance task was applied to measure the comfortable and uncomfortable distance of participants when approaching an experimenter in the same gender or opposite gender or when being approached.A self-rating anxiety scale(SAS)and a self-rating depression scale(SDS)were used to examine the anxiety and depression levels of all participants.The pain intensity,disability,and social avoidance in the CLBP group were evaluated by the Numeric Rating Scale,Roland-Morris disability questionnaire(RMDQ),and Social Avoidance and Distress Scale(SAD),respectively.The difference in the social distance under various conditions between the CLBP and healthy control groups was analyzed through an independent sample t-test.The association between social distance and different clinical indicators was tested by the Pearson correlation test.Study 2,the longitudinal intervention recruited 29 patients with CLBP from various communities in Yangpu District,Shanghai,China.The participants were divided into the moderate CLBP group and the mild CLBP group and received exercise intervention for 8 weeks.The program was performed twice a week for 60 minutes each.The assessments were conducted before and after the intervention.The interpersonal distance under various conditions in social distance tasks and pain intensity were the primary outcomes.The secondary outcomes included RMDQ,SAS,SDS.Intention to treat analysis was performed.The difference in results between the two CLBP groups was analyzed through an independent sample t-test.The intragroup differences before and after the intervention were tested by paired sample t-test.Results Study 1,when approaching a strange experimenter or when being approached,the comfortable distance(Approaching: Same-Gender: p = 0.001;Opposite Gender: p = 0.003;Being Approached: Same-Gender: p = 0.002;Opposite Gender: p = 0.001)and uncomfortable distance(Approaching: Same-Gender: p = 0.002;Opposite Gender: p = 0.002;Being Approached: Same-Gender: p = 0.002;Opposite Gender: p = 0.003)under the Same or Opposite Gender condition in the CLBP group were greater than that those of healthy control group,which was statistically significant.Gender had a significant main effect on the social distance in patients with CLBP(Comfortable Distance: F(1,93)= 4.293,p = 0.041;Uncomfortable Distance: F(1,93)= 4.293,p = 0.041).The comfortable and uncomfortable distance between individuals of the same gender was shorter than that between individuals of the opposite gender.The social distance had a significant positive correlation with the average pain intensity,score on RMDQ,SAS,and SDS in the CLBP group under the Same or Opposite Gender condition(p < 0.05).Study 2,after the 8-week exercise intervention,the social distance of patients with CLBP was shorter than that before intervention,which was significantly different(Comfortable Distance: Approaching-Opposite Gender: p = 0.003;Being Approached-Same Gender: p < 0.001;Being Approached-Opposite Gender: p < 0.001;Uncomfortable Distance: Approaching-Same Gender: p = 0.007;Approaching-Opposite Gender: p = 0.002;Being Approached-Same Gender: p < 0.001;Being Approached-Opposite Gender: p < 0.001).The score of pain intensity,unpleasantness of pain,RMDQ,SAS,SDS in the CLBP group also decreased,which was significantly different between after and before intervention(p < 0.05).In addition,the social distance,pain intensity,unpleasantness of pain,RMDQ,SAS,and SDS scores of the moderate CLBP group decreased more after the intervention compared with the mild CLBP group.There were significant differences between the two groups in the improvement of social distance and pain intensity(p < 0.05).Conclusion People with CLBP have a greater social distance from strangers.There is a positive correlation between pain intensity,disability,anxiety,depression,and social distance.Exercise intervention can not only improve the abnormal behavior of social distance regulation and shorten the social distance but also improve the pain,disability,anxiety,and depression of CLBP patients.The study reveals the impairment of psychosocial health of patients with CLBP and provides new insight into the management and rehabilitation of the disease.In the future,it is necessary to combine neuroimaging technology to explain the reasons for the increased social distance in patients with CLBP and the potential neural mechanism of exercise to improve abnormal social distance regulation behavior,to provide a basis for rehabilitation.