Pain Catastrophizing Beliefs and Neuropathic Symptoms Are Associated With a Poorer Long-Term Recovery in Chronic Plantar Heel Pain: A Cohort Study.

IMPORTANCE

Chronic plantar heel pain is common and often recalcitrant yet understanding of modifiable risk factors that influence its trajectory of recovery is limited.

OBJECTIVE

The objective of this study was to describe associations of changes in physical and psychological measures and symptom descriptors over 12 months with changes in pain, function, and quality of life in people with chronic plantar heel pain.

DESIGN

A prospective cohort with longitudinal follow-up was used.

SETTING

A community setting in southern Tasmania was used.

PARTICIPANTS

The participants were 220 people with a clinical diagnosis of chronic plantar heel pain.

EXPOSURES: The exposures were body mass index (kg/m2), waist circumference (centimeters), ankle plantarflexor strength (kilograms), ankle and first metatarsophalangeal joint dorsiflexion mobility (degrees), pain catastrophizing beliefs (Pain Catastrophizing Scale), depression (9-item Patient Health Questionnaire), multisite pain, morning stiffness, neuropathic symptoms (painDETECT), and physical activity (accelerometry).

MAIN OUTCOMES AND MEASURES: The Foot Health Status Questionnaire pain and function domains and the 6-dimension Assessment of Quality of Life Scale were used. Outcomes and exposures were assessed at baseline and 12 months. Data were analyzed using linear mixed-effects models with exposure × time interactions.

RESULTS

Increasing pain catastrophizing and neuropathic painDETECT scores over 12 months were associated with a poorer trajectory of pain recovery (pain catastrophizing interaction β = -.39 [95% CI = -0.01 to -0.77]; painDETECT interaction β = -.79 [95% CI = -0.10 to -1.48]). In full multivariable models, there were no other significant associations between any other variable and pain. The only associations with foot function and quality of life were weak negative associations of steps per day and sedentary time with function and quality of life, respectively.

CONCLUSIONS AND RELEVANCE: Increasing pain catastrophizing and neuropathic symptoms were associated with poorer pain outcomes over 12 months in individuals with chronic plantar heel pain. These findings highlight the importance of pain beliefs and neurogenic factors in the prognosis of chronic plantar heel pain. Interventions targeting pain beliefs and neuropathic mechanisms may improve outcomes in subgroups with these characteristics.