The SPADE symptom cluster and physical disability in chronic low back pain patients

Introduction: Chronic pain is a major healthcare issue. It is debilitating and often occurs simultaneously with other health issues (Murray et al., 2013; Shmagel et al., 2016). The SPADE symptom cluster (sleep disturbance, pain interference, anxiety, depression, and low energy/fatigue) is common in chronic low back pain (cLBP) patients and may interact with their disability (Alamam et al., 2019; Davis et al., 2016; Tavares et al., 2019). Methods: This cross-sectional study utilized data from the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION). The PROMIS-29 v2.0 was used to assess SPADE symptoms, and the Roland-Morris Disability Questionnaire was used to measure disability. The Spearman-Rho correlation between each SPADE symptom and disability was calculated. The correlations were then tested for significant differences and ranked in order of strongest to weakest correlation. Lastly, groups were assigned based on the number of presenting symptoms and tested for between-groups differences in mean disability. Results: Each of the five SPADE symptoms and the composite SPADE score were all positively and significantly correlated with disability. Pain Interference was most strongly correlated with disability. SPADE comorbidity was related to disability. Conclusion: SPADE symptoms greatly increase disability in chronic low back pain patients.