Environmental stressors and chronic low back pain: life events, family and work environment.

Stressors in the family and job environments have been proposed to play a role in the modulation of pain, yet direct empirical support for such a role is limited. The present study investigated the relationship between general stress, family and work environments (perceived social climate), psychological distress (anxiety, depression), and pain experience (sensory, affective, evaluative) in 33 ambulatory chronic low back pain (CLBP) subjects and 35 healthy controls matched for age, sex, socioeconomic status (SES), weight, and height. Results indicated that environmental stressors/social climate measures, including family conflict, family control, and general stress (Social Readjustment Rating Scale), were greater in the CLBP group. Distress measures were also higher in the CLBP group. Characteristics of the family and work environments were found to be more predictive of the affective and evaluative dimensions of pain. Increased family conflict was associated with increased distress and increased pain, while increased family independence was correlated with less distress and increased pain. Less peer cohesion, less physical comfort, and less job clarity were correlated with increased pain, but not distress. Work pressure was associated with decreased depression and less pain. These findings suggested the presence of both stress and operant mechanisms in the modulation of pain in the family, while operant and distraction mechanisms appear to characterize the relationship among work environment factors and pain.