Negative body image in chronic lumbosacral (pseudo) radicular pain: Unique contribution of central sensitization symptoms

Body image (BI) disturbance is increasingly recognized as a relevant psychological factor in chronic pain. Yet, its multidimensional construct, association with central sensitization (CS) and broader biopsychosocial variables remain poorly understood. This cross-sectional study aimed to examine associations between BI and biopsychosocial factors, including CS symptoms, in patients with chronic lumbosacral (pseudo)radicular pain, and to compare BI scores with those of the general population. Two hundred four patients referred to an outpatient pain clinic in the Netherlands between November 2023 and August 2024 completed questionnaires assessing BI, CS symptoms, and psychological and functional variables. Data were compared with a general population sample (n = 761). BI was assessed with the Dresden Body Image Questionnaire (DBIQ-NL). Hierarchical regression analyses examined associations between BI and biopsychosocial predictors, and group comparisons were conducted using structural equation modeling with inverse probability weighting. BI was associated with female sex, higher body mass index (BMI), elevated anxiety and depressive symptoms, and greater CS symptoms (adjusted R2 = 0.487, P < .001). CS symptoms explained 17% of the variance in BI, representing the strongest single predictor. Compared with the general population, patients demonstrated markedly lower BI across all domains (weighted Cohen's d = 2.9-9.93), even after adjusting for demographic covariates. These findings indicate that BI disturbance is highly prevalent and clinically relevant in chronic lumbosacral (pseudo)radicular pain. Its strong association with CS and affective symptoms suggests that integrative, body-focused interventions may represent a valuable target within multidisciplinary pain management.