Pain-related Guilt in Low Back Pain

Objectives: Identifying mechanisms that mediate recovery is
imperative to improve outcomes in low back pain (LBP). Qualitative
studies suggest that guilt may be such a mechanism, but
research on this concept is scarce, and reliable instruments to
measure pain-related guilt are not available.
Methods: We addressed this gap by developing and testing a Painrelated
Guilt Scale (PGS) for people with LBP. Two samples of
participants with LBP completed the scale and provided data on
rates of depression, anxiety, pain intensity, and disability.
Results: Three factors were identified using exploratory factor
analysis (n=137): “Social guilt,” (4 items) relating to letting down
family and friends; “Managing condition/pain guilt,” (5 items)
relating to failing to overcome and control pain; and “Verification
of pain guilt,” (3 items) relating to the absence of objective evidence
and diagnosis. This factor structure was confirmed using confirmatory
factor analysis (n=288), demonstrating an adequate to
good fit with the data (AGFI=0.913, RMSEA=0.061). The PGS
subscales positively correlated with depression, anxiety, pain
intensity, and disability. After controlling for depression and anxiety
the majority of relationships between the PGS subscales and
disability and pain intensity remained significant, suggesting that
guilt shared unique variance with disability and pain intensity
independent of depression and anxiety. High levels of guilt were
reported by over 40% of participants.
Discussion: The findings suggest that pain-related guilt is common
and is associated with clinical outcomes. Prospective research is
needed to examine the role of guilt as a predictor, moderator, and
mediator of patients’ outcomes.