# Exploring pain conceptualization in relation to outcomes in patients with chronic low back pain: a prospective observational study

## TL;DR

This study explores how patients with chronic low back pain understand pain and how that understanding relates to treatment outcomes and education level.

## Contribution

The study introduces the Croatian COPI-Adult as a reliable tool and shows that education level influences pain conceptualization.

## Key findings

- Higher pain conceptualization scores were weakly linked to better pain and disability outcomes.
- Educational attainment significantly influenced pain conceptualization scores.
- Pain conceptualization did not predict the degree of improvement after physiotherapy.

## Abstract

To examine the relationship between pain conceptualization and treatment outcomes in patients with chronic nonspecific low back pain (CNSLBP) undergoing physiotherapy, and to explore the influence of educational attainment on pain conceptualization.

This prospective observational study enrolled 84 adults (mean age ≈50 years) receiving exercise-based physiotherapy for CNSLBP in an outpatient setting. Outcome measures included pain intensity (Numeric Pain Rating Scale), disability (Roland-Morris Disability Questionnaire), and health-related quality of life (EQ-5D-5L index and EQ-VAS), assessed before and after treatment. Pain conceptualization was measured with the Croatian version of the Concept of Pain Inventory for Adults (COPI-Adult).

Significant post-treatment improvements were observed in pain (−2.41), disability (−5.27), EQ-5D-5L index (+0.128), and EQ-VAS (+13.79) (all P < 0.001). Higher COPI-Adult scores were weakly and negatively correlated with pain (r = −0.273, P = 0.012) and disability (r = −0.259, P = 0.018), and positively with HRQoL (EQ-5D-5L: r = 0.295; EQ-VAS: r = 0.323). However, pain conceptualization did not significantly moderate the magnitude of outcome changes (all interaction effects P > 0.005). Participants with higher education scored significantly higher on COPI-Adult (P = 0.014; d = 0.55).

While pain conceptualization is associated with post-treatment pain, disability, and HRQoL outcomes, it does not predict the degree of improvement after physiotherapy. Educational attainment influences pain conceptualization, which indicates a need for tailored communication strategies in rehabilitation. The Croatian COPI-Adult is a reliable tool for assessing patients' concepts of pain within CNSLBP care.