Deciphering the Causal Relationships Between Low Back Pain Complications, Metabolic Factors, and Comorbidities

Nader Tarabeih; Alexander Kalinkovich; Adel Shalata; Stacey S Cherny; Gregory Livshits

doi:10.2147/JPR.S349251

Deciphering the Causal Relationships Between Low Back Pain Complications, Metabolic Factors, and Comorbidities

J Pain Res. 2022 Jan 29:15:215-227. doi: 10.2147/JPR.S349251. eCollection 2022.

Authors

Nader Tarabeih^{1

2}, Alexander Kalinkovich¹, Adel Shalata³, Stacey S Cherny¹, Gregory Livshits^{1

4}

Affiliations

¹ Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
² Maale HaCarmel Mental Health Center, Affiliated to Rappaport Faculty of Medicine Technion, Israel Institute of Technology, Haifa, Israel.
³ The Simon Winter Institute for Human Genetics, Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
⁴ Adelson School of Medicine, Ariel University, Ariel, Israel.

Abstract

Purpose: Low back pain (LBP) is one of the major disabling health conditions in aging societies presenting significant cost burdens to health and social care systems. Its complications and associated disability are often accompanied by mental disorders, metabolic comorbidities, changed body composition, and inflammation. However, their mutual relationships in LBP-associated disability remain unclear.

Methods: In the present case-control study, a self-report validated questionnaire was used to collect LBP disability data in an ethnically homogeneous Israeli Arab sample (489 males and 589 females). Body composition parameters were assessed through bioelectrical impedance analysis and plasma levels of soluble markers by EISA. Comorbidity status was assessed in personal interview and from the individual medical files.

Results: Our mixed multiple regression analysis identified that GDF-15 (β = 0.160, p = 2.95×10-8), vaspin (β = 0.085, p = 0.003), follistatin (β = 0.076, p = 0.001), extracellular water (β = 0.096, p = 0.001), waist hip ratio (β = 0.072, p = 0.009), mental disorders (β = 0.077, p = 0.001), and metabolic comorbidities (β = 0.059, p = 0.02) were significantly associated with LBP disability scores, when controlling for age and sex effects. Additive Bayesian network modelling further suggests that LBP disability appears to be directly influenced by age, sex, GDF-15, and extracellular water, and indirectly by mental and metabolic disorders, waist-hip ratio, and follistatin. LBP, in turn, seems to affect the vaspin levels directly.

Conclusion: Our data suggest the existence of a complex, age-associated, and probably hierarchical, relationship between LBP disability and mental and metabolic disorders, inflammation-related soluble markers, and body composition parameters.

Keywords: GDF-15; body composition; comorbidities; depression; disability; follistatin; low back pain; vaspin.

Grants and funding

This research was funded by the Israel Science Foundation, grant number 2054/19, and also supported by Ariel University Research & Development Department, grant number RA2000000457.