Alexithymia and 7.5-year incidence of compensated low back pain in 1207 urban public transit operators

Abstract

Objective-Alexithymia, a lack of emotional awareness, was positively associated with selfreported low back pain (LBP) in cross-sectional studies. We assessed the association of alexithymia with 7.5-year incidence of LBP prospectively in a cohort study of 1,207 San Francisco transit operators.Methods-Alexithymia was measured by the Toronto Alexithymia Scale (TAS-20). LBP was assessed by physician-confirmed diagnoses from administrative workers' compensation data. Cox proportional hazard analyses controlled for demographic, behavioral, and physical and psychosocial job factors measured by questionnaire and interview.Results-27.7% of all drivers (n=334) filed compensated claims for LBP injuries with workers' compensation insurance during the 7.5-year observation time. The hazard ratios from the fully adjusted model were 0.73 (0.56-0.96) for the TAS-20 scale and 0.82 (0.69-0.98) for the subscale "difficulty describing feelings". Alexithymia scores did not predict the duration of compensated work disability.Conclusion-In contrast to previous cross-sectional positive associations between alexithymia and LBP, alexithymia is negatively associated with compensated LBP claims. We hypothesize that shame and reporting behavior may explain these inconsistent results.

Relationships among alexithymia and pain intensity, pain interference, and vitality in persons with neuromuscular disease: Considering the effect of negative affectivity

“…Subscale reliability ranged from quite good (Difficulty Identifying Feelings scale, Cronbach’s alpha = .80; Difficulty Describing Feelings scale, Cronbach’s alpha = .76) to marginal (Externally-Oriented Thinking scale, Cronbach’s alpha = .59). The relatively low internal consistency of the Externally-Oriented Thinking scale is typical and has been found in other studies [28]. …”

“…Alexithymia has been shown to be associated with pain in patients with chronic myofascial pain [25], temporomandibular disorder [11], rheumatoid arthritis [24], migraine headaches [24], systemic lupus erythematosus [24], low back pain [28], fibromyalgia [15], and cancer pain [30]. Alexithymia has also been shown to predict depression [19, 25], anxiety [19], and physical impairment [25] in patients with various chronic pain conditions.…”

Alexithymia as a prognostic risk factor for health problems: a brief review of epidemiological studies

“…Seven studies prospectively examined the developmental risks of alexithymia for health problems among nonclinical populations [14-20]. Among them, 3 studies demonstrated the statistically significant adverse risk of baseline alexithymia for subsequent health problems [14-16], 3 studies reported no association [18-20], and one reported the beneficial effect of alexithymia on health [17]. …”

“…Two studies examined the predictive value of alexithymia on the development of low-back pain (LBP) [17,19]. One study found no association between baseline alexithymia that was evaluated by projective personality tests and the reported severity of neck–shoulder pain and/or LBP among 154 subjects, randomly selected from the general population [19].…”

“…One study found no association between baseline alexithymia that was evaluated by projective personality tests and the reported severity of neck–shoulder pain and/or LBP among 154 subjects, randomly selected from the general population [19]. The other study examined 1,207 municipal bus drivers and found a favorable association between alexithymia and the 7.5-year incidence of compensated LBP [17]. Inversely, the same research group reported an adverse association between alexithymia and LBP claims from cross-sectional data derived from the same population [23].…”