Depression and Insomnia Mediate the Link Between Problematic Internet Use and Neuropathic Low Back Pain: Evidence from a Cross-Sectional Survey

Objective: The spread of digital technologies has drawn attention to the health effects of problematic internet use (PIU). This study investigated whether PIU is associated with chronic low back pain, focusing on its neuropathic component and potential mediating factors. Methods: A cross-sectional online survey was conducted among part-time university students aged 18-65 years. The questionnaire collected demographic, lifestyle, and health-related data, including depression, insomnia, and pain characteristics. Standardized instruments were used: the Problematic Internet Use Questionnaire (PIUQ), Beck Depression Inventory-Short Form (BDI-SF), Athens Insomnia Scale (AIS), and the painDETECT questionnaire. Statistical analyses included chi-square tests, correlations, hierarchical linear regression, and mediation modeling. Analyses were performed on the full sample (N = 550). Results: The prevalence of chronic low back pain was 46.2%, with 12.2% reporting neuropathic pain. PIU was present in 8.4% of respondents, depression in 69.6%, and insomnia in 5.8%. Neuropathic pain correlated with PIU (r = 0.126, p < 0.05), depression (r = 0.44, p < 0.001), and insomnia (r = 0.33, p = 0.009). In regression analysis, depression (β = 0.256, p = 0.001), headache/migraine (β = 0.20, p = 0.002), smoking (β = 0.135, p = 0.030), and cardiovascular disease (β = 0.129, p = 0.045) were independent predictors of higher painDETECT scores. PIU was not a direct predictor but exerted significant indirect effects: mediation analyses confirmed indirect paths via depression (b = 0.08, p < 0.001) and insomnia (b = 0.05, p = 0.009). Conclusion: Chronic low back pain is influenced by psychological, sleep, and lifestyle factors. Although PIU was not an independent predictor of neuropathic pain, it indirectly increased risk through depression and insomnia. Screening and management of these comorbidities should be incorporated into prevention and treatment strategies.