Statistical data show that pain intensity in patients with low back pain is associated with a higher BMI, total serum cholesterol, and triacylglycerol levels. The objective of our study was to evaluate how these associations are dependent on the nature of the patient-doctor relationship. Eighty-nine patients hospitalized with chronic low-back pain (50 women, 39 men; average age: 64.5 ± 12.7 years) were assessed over a 3-year period. A serum lipid analysis was conducted (LDL-C, HDL-C, and total cholesterols) at admission in parallel with a subjective evaluation of pain intensity, which was assessed using a numeric rating scale. The participating physician assigned, based on their personal interaction with the patient, an attribute of affinity (positive, neutral, and negative) towards them. Current serum lipid levels and pain intensity were correlated relative to these attributes. Pain intensity did not differ between the groups assigned positive or negative attributes of affinity. In patients belonging to the "positive" group, pain intensity correlated positively with total cholesterol (p=0.01) and LDL cholesterol (p=0.007). No correlations were found in the "negative" group or when the patient-doctor relationship was ignored. We found a significant association between subjectively assessed low back pain intensity and serum levels of total and LDL cholesterol in patients with whom the physician had a positive affinity. A positive affinity with the patients having chronic pain and the patient's trust in their physicians may ultimately mean that the patient's statement about pain is more credible, which may retroactively affect the outcome of therapy.

Charles University 3rd Faculty of Medicine Department of Medical Biophysics and Medical Informatics Prague Czech Republic

Charles University 3rd Faculty of Medicine Department of Physiology Prague Czech Republic

Department of Neurology Hospital Horovice Horovice Czech Republic

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Handwerker H. O., Kobal G. Psychophysiology of experimentally induced pain. Physiological Reviews . 1993;73(3):639–671. doi: 10.1152/physrev.1993.73.3.639. PubMed DOI

Lee M. C., Tracey I. Imaging pain: a potent means for investigating pain mechanisms in patients. British Journal of Anaesthesia . 2013;111(1):64–72. doi: 10.1093/bja/aet174. PubMed DOI PMC

Garcia J. B. S., Garcia J. B. S., Viera E. B., Santos A. M., Bertrand R. H. Pupillometry: the influence of gender and anxiety on the pain response. Pain Physician . 2013;16(3):E257–E266. doi: 10.36076/ppj.2013/16/e257. PubMed DOI

Ellermeier W., Westphal W. Gender differences in pain ratings and pupil reactions to painful pressure stimuli. Pain . 1995;61(3):435–439. doi: 10.1016/0304-3959(94)00203-q. PubMed DOI

de Tommaso M., Ricci K., Libro G., et al. Pain processing and vegetative dysfunction in fibromyalgia: a study by sympathetic skin response and laser evoked potentials. Pain Res Treat . 2017;2017:12. doi: 10.1155/2017/9747148.9747148 PubMed DOI PMC

Melzack R. The McGill pain questionnaire. In: Melzack R., editor. Pain Measurement and Assessment . New York: Raven Press; 1983.

Noble B., Clark D., Meldrum M., et al. The measurement of pain, 1945-2000. Journal of Pain and Symptom Management . 2005;29(1):14–21. doi: 10.1016/j.jpainsymman.2004.08.007. PubMed DOI

Melzack R., Torgerson W. S. On the language of pain. Anesthesiology . 1971;34(1):50–59. doi: 10.1097/00000542-197101000-00017. PubMed DOI

Cleeland C. S. Pain assessment in cancer. In: Osoba D., editor. Effect of Cancer on Quality of Life . Boca Raton: CRC Press, Inc; 1991.

Dworkin R. H., Turk D. C., Farrar J. T., et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain . 2005;113(1):9–19. doi: 10.1016/j.pain.2004.09.012. PubMed DOI

Rokyta R. Biochemical and electrophysiological changes in animal models of chronic and visceral pain. In: Kleppinger J., editor. Pain Clinical Aspects and Therapeutical Issues, Part III. Linz . Selva Verlag: 1998.

Křikava K., Kalla K., Yamamotová A., Rokyta R. Blood serum changes in patients with pain during bone fractures and acute pancreatitis. Neuroendocrinology Letters . 2004;25(1-2):62–69. PubMed

Rokyta R., Haklova O., Yamamotova A. Assessment of chronic benign and cancer pain using blood plasma biomarkers. Neuroendocrinology Letters . 2009;30(5):637–642. PubMed

Yamamotová A., Srámková T., Rokyta R. Intensity of pain and biochemical changes in blood plasma in spinal cord trauma. Spinal Cord . 2010;48(1):21–26. doi: 10.1038/sc.2009.71. PubMed DOI

Rokyta R., Yamamotová A., Sulc R., Trefil L., Racek J., Treska V. Assessment of biochemical markers in patients with pain of vascular origin. Clinical and Experimental Medicine . 2008;8(4):199–206. doi: 10.1007/s10238-008-0001-5. PubMed DOI

Epstein R. M., Hadee T., Carroll J., Meldrum S. C., Lardner J., Shields C. G. „Could this be something,?“ Reassurance, uncertainty, and empathy in response to patients´ expressions of worry. Journal of General Internal Medicine . 2007;22(12):1731–1739. doi: 10.1007/s11606-007-0416-9. PubMed DOI PMC

Wilsgaard T., Arnesen E. Change in serum lipids and body mass index by age, sex, and smoking status: the Tromsø study 1986-1995. Annals of Epidemiology . 2004;14(4):265–273. doi: 10.1016/j.annepidem.2003.08.004. PubMed DOI

Singer T., Seymour B., O’Doherty J., Kaube H., Dolan R. J., Frith C. D. Empathy for pain involves the affective but not sensory components of pain. Science . 2004;303(5661):1157–1162. doi: 10.1126/science.1093535. PubMed DOI

Shiri R., Karppinen J., Leino-Arjas P., Solovieva S., Viikari-Juntura E. The association between obesity and low back pain: a meta-analysis. American Journal of Epidemiology . 2010;171(2):135–154. doi: 10.1093/aje/kwp356. PubMed DOI

Leach M. J. Rapport: a key to treatment success. Complementary Therapies in Clinical Practice . 2005;11(4):262–265. doi: 10.1016/j.ctcp.2005.05.005. PubMed DOI

Jinkins J. R., Whittemore A. R., Bradley W. G. The anatomic basis of vertebrogenic pain and the autonomic syndrome associated with lumbar disk extrusion. American Journal of Roentgenology . 1989;152(6):1277–1289. doi: 10.2214/ajr.152.6.1277. PubMed DOI

Tape T. G. Interpreting Diagnostic Tests, Nebraska Medical Center . Omaha, NE 68198, USA: 2020. The area under an ROC curve [online], university of Nebraska medical center.

Leino-Arjas P., Kauppila L., Kaila-Kangas L., Shiri R., Heistaro S., Heliovaara M. Serum lipids in relation to sciatica among Finns. Atherosclerosis . 2008;197(1):43–49. doi: 10.1016/j.atherosclerosis.2007.07.035. PubMed DOI

Heuch I., Heuch I., Hagen K., Zwart J.-A. Do abnormal serum lipid levels increase the risk of chronic low back pain? The Nord-Trøndelag Health Study. PLoS One . 2014;9 doi: 10.1371/journal.pone.0108227.e108227 PubMed DOI PMC

Shcherbina A., Longacre M. The association between atherosclerosis and low back pain: a systematic review. PM&R . 2017;9(11):1144–1156. doi: 10.1016/j.pmrj.2017.04.007. PubMed DOI

Dunham C., Fealk M. H., Sever W. E., III Following severe injury, hypocholesterolemia improves with convalescence but persists with organ failure or onset of infection. Critical Care . 2003;7(6):R145–R153. doi: 10.1186/cc2382. PubMed DOI PMC

Seidell J. C., Cigolini M., Charzewska J., et al. Fat distribution and gender differences in serum lipids in men and women from four European communities. Atherosclerosis . 1991;87(2-3):203–210. doi: 10.1016/0021-9150(91)90022-u. PubMed DOI

Vitale C., Fini M., Speziale G., Chierchia S. Gender differences in the cardiovascular effects of sex hormones. Fundamental & Clinical Pharmacology . 2010;24(6):675–685. doi: 10.1111/j.1472-8206.2010.00817.x. PubMed DOI

Leino-Arjas P., Kaila-Kangas L., Solovieva S., Riihimäki H., Kirjonen J., Reunanen A. Serum lipids and low back pain: an Association? A follow-up study of a working population sample. Spine . 2006;31(9):1032–1037. doi: 10.1097/01.brs.0000214889.31505.08. PubMed DOI

Heuch I., Heuch I., Hagen K., Zwart J.-A. Associations between serum lipid levels and chronic low back pain. Epidemiology . 2010;21(6):837–841. doi: 10.1097/ede.0b013e3181f20808. PubMed DOI

Ozgocmen S., Ardicoglu O. Lipid profile in patients with fibromyalgia and myofascial pain syndromes. Yonsei Medical Journal . 2000;41(5):541–545. doi: 10.3349/ymj.2000.41.5.541. PubMed DOI

Kamel E. M., Elsaid A. F., Gumaa E. A., El Sheweal A. E. M. Statins attenuate hyperalgesia and inflammation in experimentally induced acute and chronic pain in rats. Ain-Shams Journal of Anaesthesiology . 2016;9:440–448.

Stein E. A., Lane M., Laskarzewski P. Comparison of statins in hypertriglyceridemia. The American Journal of Cardiology . 1998;81(4):66B–69B. doi: 10.1016/s0002-9149(98)00041-1. PubMed DOI

Wierzbicki A. S., Poston R., Ferro A. The lipid and non-lipid effects of statins. Pharmacology & Therapeutics . 2003;99(1):95–112. doi: 10.1016/s0163-7258(03)00055-x. PubMed DOI

Bhalla S., Singh N., Jaggi A. S. Statins: do they aggravate or ameliorate neuropathic pain? The Journal of Pain . 2014;15(11):1069–1080. doi: 10.1016/j.jpain.2014.06.012. PubMed DOI

Nekovarova T., Yamamotova A., Vales K., Stuchlik A., Fricova J., Rokyta R. Common mechanisms of pain and depression: are antidepressants also analgesics? Frontiers in Behavioral Neuroscience . 2014;8:p. 99. doi: 10.3389/fnbeh.2014.00099. PubMed DOI PMC

Hojat M., Gonnella J. S., Mangione S., Nasca T. J., Magee M. Physician empathy in medical education and practice: experience with the Jefferson scale of physician empathy. Seminars in Integrative Medicine . 2003;1:25–41. doi: 10.1016/s1543-1150(03)00002-4. DOI

Marci C. D., Ham J., Moran E., Orr S. P. Physiologic correlates of perceived therapist empathy and social-emotional process during psychotherapy. The Journal of Nervous and Mental Disease . 2007;195(2):103–111. doi: 10.1097/01.nmd.0000253731.71025.fc. PubMed DOI

Benedetti F. Placebo and the new physiology of the doctor-patient relationship. Physiological Reviews . 2013;93(3):1207–1246. doi: 10.1152/physrev.00043.2012. PubMed DOI PMC

Gordon R., Bloxham S. A systematic review of the effects of exercise and physical activity on non-specific chronic low back pain. Health Care . 2016;4(2):p. 22. doi: 10.3390/healthcare4020022. PubMed DOI PMC

Luan X., Tian X., Zhang H., et al. Exercise as a prescription for patients with various diseases. Journal of Sport and Health Science . 2019;8(5):422–441. doi: 10.1016/j.jshs.2019.04.002. PubMed DOI PMC

Mann S., Beedie C., Jimenez A. Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile: review, synthesis and recommendations. Sports Medicine . 2014;44(2):211–221. doi: 10.1007/s40279-013-0110-5. PubMed DOI PMC

Leon A. S., Sanchez O. A. Response of blood lipids and lipoproteins to exercise training alone or combined with dietary intervention. Medicine & Science in Sports & Exercise . 2018;33 PubMed