Back Pain and The Mind

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Here is another article on the fascinating link between back pain and the

mind.

Spine 2001 Oct 15;26(20):2271-7

Health-related quality of life and somatization in patients with long-term

low back pain: a prospective study with 109 patients.

Nickel R, Egle UT, Eysel P, Rompe JD, Zollner J, Hoffmann SO.

STUDY DESIGN: For this study, a prospective cohort of 109 patients was

recruited consecutively at an orthopedic inpatient unit of a university

hospital. Three self-report instruments were administered to patients with

sciatica believed to be caused by a herniated lumbar disc to examine their

quality of life and psychic stress at baseline and at the 1-year follow-up

visit.

OBJECTIVES: To investigate whether patients who have undergone a previous

discectomy experience greater psychic stress than patients with no surgery,

and to determine whether the groups differed regarding their health-related

quality of life at the follow-up visit.

SUMMARY OF BACKGROUND DATA: Previous studies have described psychic

abnormalities in patients with long-term back pain, particularly patients

with severe chronicity (i.e., history of surgeries and persistent problems)

or those who underwent a previous discectomy. Additionally, a series of

studies has shown that psychic and psychosocial parameters exert a

significantly greater influence on the success of treatment than do clinical

and imaging findings or the extent of disc abnormality.

METHODS: The Short Form Health Survey 36, the Symptom Checklist 90, and

Screening for Somatoform Disorders were administered to 109 patients

consecutively treated in the authors' orthopedic university clinic, at

baseline and at the 1-year follow-up visit.

RESULTS: In all the patients examined, the physical and mental quality of

life improved regardless of their group classification. The psychological

distress, according to the Symptom Checklist 90, was clearly reduced in both

groups at the follow-up visit, with the exception of somatization, as

indicated by Symptom Checklist 90 and Screening for Somatoform Disorders.

Whereas the patients who had undergone surgery remained nearly unchanged

with regard to their somatization, the patients with no previous surgery

improved significantly, as indicated by Screening for Somatoform Disorders

and Symptom Checklist 90. Somatization, particularly that surveyed by the

comprehensive Screening for Somatoform Disorders, proved to be quite a

stabile factor over time in both groups. The extent of the physical

impairment before treatment was nearly the same in both groups, as indicated

by Short Form Health Survey 36. Despite a markedly higher chronicity of

reported problems, patients who had undergone surgery were hardly more

greatly impaired in terms of their mental quality of life and psychological

distress, as indicated by Symptom Checklist 90, than those without a history

of surgery. At the follow-up visit, the differences tended to be minimal as

well.

As compared with those who had no previous surgeries, the patients who had

undergone surgery were significantly more heavily impaired in their physical

quality of life despite significant improvements.

CONCLUSIONS: Patients with sciatica demonstrated less abnormality in terms

of the psychopathologic markers investigated than described in previous

studies. Nevertheless, the predisposition to somatize influences

health-related quality of life to a high degree.

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Dr Mel C Siff

Denver, USA

http://groups.yahoo.com/group/Supertraining/