Pain is the most frequently cited condition for emergency department visits [1, 2, 3] and recurrent physician consultations [4, 5]. Chronic low back pain (CLBP) is the most common reason for medical visits and the use of auxiliary healthcare services [3, 6]. The International Association for the Study of Pain [IASP] defined pain as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” [5, p. 2]. CLBP, therefore, occurs when low back pain (LBP) persists for more than 1 month after anticipated tissue healing or if it has been present for at least 3 of the previous 6 months. It affects the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen and the skin covering the lumbar area and may be accompanied by leg pain [7].
In Africa, findings show that CLBP is one of the major health concerns, showing high prevalence and disability rates [8, 9]. Nakua et al. [10] indicated that CLBP is high in prevalence together with arthritis/joint pain in Ghana. The condition is predominant among the aged [11] and women [12]. CLBP contributes to the highest health cost in South Africa [6]. Out of the 369 disease and injury conditions studied in the 2019 Global Burden of Disease among 204 countries and territories, CLBP ranked highest in terms of disability and was reported to be sixth in terms of overall burden [13]. Available evidence shows that most individuals who report LBP go on to have recurrent or persistent symptoms [14], which leads to CLBP [15]. The impact of CLBP on people’s lives is therefore not only heinous but enervating.
For instance, depression is associated with an array of poor pain outcomes and worse prognosis [16]. Patients with CLBP and comorbid depression experienced more pain sensitivity and complaints [17], more intense pain [18], more amplification of pain symptoms [19] and longer duration of pain [20].
Catastrophizing pain is highly predominant in CLBP patients [21, 22]. The presence of catastrophizing of pain leads to negative expectations about the painful experience and exaggerated worry about the consequences [23]. Pain catastrophizing independently predicts pain intensity six months later, even when controlling for level of intensity and disability [22]. Again, catastrophizing of pain may cause perceived lack of control over symptoms and inability to cope with pain [24].
One other factor that has a great impact on pain in general [25] and CLBP in particular [26] is the patient’s interaction with the environment. However, research conducted in Ghana among CLBP has focused on physical pain [10, 27] without assessing the associated psychosocial aspects. Hence, the dynamic interactive roles of social support and psychopathologies in CLBP experience and intervention have not yet been accounted for. Social support is defined as the presence of a mutual support system about one's health and includes all favourable resources acquired from others, such as family, friends, and medical professionals [28]. Through strong social support, patients with chronic pain learn to be resilient, which may be advantageous throughout the course of the illness [29]. Negatively perceived social support, on the other hand, may exacerbate emotional distress symptoms, including despair and anxiety, which can lead to a decline in quality of life [30]. These findings emphasize the crucial role that social support plays in easing pain and discomfort.
This underscores the position advocated by Engel [31] that ailment and treatment of ailment should not be central to biomedical science alone but beyond a purely biomedical view of a patient's health. Engel therefore proposed the biopsychosocial (BPS) model, which acknowledges the complex interplay of biological, psychological, and social life factors [31, 32, 33]. According to the BPS model, the interplay between these three components determines how well or sick a person is. Thus, how they interact influences how an illness develops, manifests, and ends. A patient's physical health issues, for instance, can be made worse by issues with their emotional or social well-being. Without addressing the problems outside of physical health, illness may present with more severe or persistent symptoms that make treatment more difficult [33]. This model offers a more comprehensive approach to treating health issues and provides a basis for interventions that may address multiple targets rather than just nociceptive processes, which underpins the current study. However, more research is needed to discover whether social support can help to moderate pain in people with chronic LBP, one of the considerations in the present study.
Therefore, this study assessed not only the psychopathologies associated with CLBP but also the role of perceived social support in CLBP intervention, thereby highlighting the need for the adoption of the BPS of health in CLBP treatment, which has proven highly efficacious elsewhere [34, 35]. This study, therefore, assessed the relationship between psychopathological conditions, perceived social support and CLBP among patients with CLBP. Specifically, the study assessed the influence of CLBP on depression, anxiety, social support and catastrophizing of thoughts and the moderating role of social support on the relationship between CLBP and catastrophizing.