Hypervigilance to Pain May Predict the Transition from Subacute to Chronic Back Pain: A Longitudinal Observational Study

Wen Zhang,1 Martin Löffler,1,2 Katrin Usai,1 Mina Mišić,1 Frauke Nees,1,3,* Herta Flor1,* 1Department of Neuropsychology and Psychological Resilience Research, Research Group Learning and Brain Plasticity in Mental Disorders, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; 2Clinical Psychology, Department of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; 3Institute of Medical Psychology and Medical Sociology, University Medical Centre Schleswig-Holstein, Kiel University, Kiel, Germany*These authors contributed equally to this workCorrespondence: Wen Zhang, Department of Neuropsychology and Psychological Resilience Research, Research Group Learning and Brain Plasticity in Mental Disorders, Central Institute of Mental Health, Square J5, Mannheim, 68159, Germany, Tel +49 621 1703-6302, Fax +49 621 1703-6305, Email [email protected]: This study aimed to evaluate whether incorporating additional psychological and social risk factors, beyond those captured by the Örebro Musculoskeletal Pain Questionnaire (ÖMPQ), could enhance the prediction of the transition from subacute to chronic back pain.Patients and Methods: Data of 75 patients with subacute back pain (SABP, 7– 12 weeks) from a longitudinal observational study were analyzed. The ÖMPQ and additional emotional, cognitive, behavioural, and social factors were assessed at baseline. Pain severity and pain-related interference were assessed at baseline and six months later to evaluate chronicity. Principal component analysis reduced psychological variables into interpretable components. Pearson’s correlation examined relationships between psychological factors, pain severity, and pain interference at baseline and 6-month follow-up. Factors linked to pain persistence were identified using best subsets regression and tested in multistage linear regression: (1) without baseline adjustment, (2) with baseline adjustment, and (3) assessing the effect of predictors from the previous steps on 6-month outcomes.Results: The ÖMPQ and the Pain Vigilance and Awareness Questionnaire (PVAQ) scores significantly predicted pain severity, and the ÖMPQ, the Pain Behaviour Checklist (PBC), and PVAQ scores significantly predicted pain-related interference after six months. Multistage linear regression showed that PVAQ scores best predicted both pain severity (ß = 0.25, p = 0.017) and pain-related interference (ß = 0.33, p = 0.002) six months later, even after adjusting baseline pain levels.Conclusion: The ÖMPQ score initially predicted pain persistence at six months, but its effect diminished after adjusting for baseline pain levels. In contrast, psychological risk factors such as pain hypervigilance and pain behaviors emerged as predictors of the pain severity or pain-related interference at six months. Pain hypervigilance became the strongest predictor of both pain severity and pain-related interference, regardless of initial pain, suggesting it as a target for early intervention.Keywords: back pain, longitudinal studies, surveys and questionnaires, risk factors, anxiety, cognition