Original scientific paper
https://doi.org/10.3325/cmj.2025.66.406
Exploring pain conceptualization in relation to outcomes in patients with chronic low back pain: a prospective observational study
Iva Lončarić Kelečić
; University Hospital Center Zagreb, Zagreb, Croatia
*
Snježana Schuster
; Department of Physiotherapy, University of Applied Health Sciences Zagreb, Zagreb, Croatia
* Corresponding author.
Abstract
Aim To examine the relationship between pain conceptu
alization and treatment outcomes in patients with chronic
nonspecific low back pain (CNSLBP) undergoing physio
therapy, and to explore the influence of educational attain
ment on pain conceptualization.
Methods This prospective observational study enrolled
84 adults (mean age ≈50 years) receiving exercise-based
physiotherapy for CNSLBP in an outpatient setting. Out
come measures included pain intensity (Numeric Pain Rat
ing Scale), disability (Roland-Morris Disability Question
naire), and health-related quality of life (EQ-5D-5L index
and EQ-VAS), assessed before and after treatment. Pain
conceptualization was measured with the Croatian version
of the Concept of Pain Inventory for Adults (COPI-Adult).
Results Significant post-treatment improvements were
observed in pain (−2.41), disability (−5.27), EQ-5D-5L index
(+0.128), and EQ-VAS (+13.79) (all P < 0.001). Higher COPI
Adult scores were weakly and negatively correlated with
pain (r = −0.273, P = 0.012) and disability (r = −0.259, P =
0.018), and positively with HRQoL (EQ-5D-5L: r = 0.295; EQ
VAS: r = 0.323). However, pain conceptualization did not
significantly moderate the magnitude of outcome chang
es (all interaction effects P > 0.005). Participants with high
er education scored significantly higher on COPI-Adult (P
= 0.014; d = 0.55).
Conclusions While pain conceptualization is associated
with post-treatment pain, disability, and HRQoL outcomes,
it does not predict the degree of improvement after phys
iotherapy. Educational attainment influences pain concep
tualization, which indicates a need for tailored communi
cation strategies in rehabilitation. The Croatian COPI-Adult
is a reliable tool for assessing patients’ concepts of pain
within CNSLBP care.
Keywords
Hrčak ID:
352560
URI
Publication date:
21.12.2025.
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