Psychological Aspects of Chronic Low Back Pain

Abstract

Background: Patients with chronic low back pain present physicians with diagnostic and therapeutic problems. Physical treatments tend to have low success rates and it is postulated that this may be because low back pain can be a manifestation of abnormal illness behaviour. Methods: A structured prospective study determined the prevalence of somatization in a sample of 131 adult patients with chronic low back pain using the Illness Behaviour Questionnaire (IBQ) and the Modified Somatic Perception Questionnaire (MSPQ). The scores on these psychological questionnaires were compared with the blind interpretation of pain distribution drawings and with the results of a mechanical classification of the patient's symptoms and signs. Results: Fifty‐four per cent of patients had four or more (out of five) abnormal illness indicators. The MSPQ values for the group were significantly above the control values in the literature. Thirty‐two per cent of pain diagrams were thought to be incompatible with an organic cause when assessed by an orthopaedic surgeon and sixty‐two per cent when assessed by a psychiatrist. Conclusions: Psychosocial factors are dominant in the presentation of chronic low back pain in adults and the disorder is not primarily a musculoskeletal one.

Accuracy of the Modified Somatic Perception Questionnaire and Pain Disability Index in the Detection of Malingered Pain-Related Disability in Chronic Pain

“…The PDI reliably measures self-assessed functional ability in seven areas: occupational, home/family, recreational, social, sexual, activities of daily living, and life support (Gronblad et al, 1993;Tait, Chibnall, & Krause, 1990;Tait, Pollard, Margolis, Duckro, & Krause, 1987). Similar to the MMPI, both are useful for identifying patients whose physical symptom presentations and disability are influenced by non-organic factors (Petrak, Hardt, Kappis, Nickel, & Tiber Egle, 2003;Sikorski, Stampfer, Cole, & Wheatley, 1996). For instance, Brasseux, Greve, Gianoli, Soileau, and Bianchini (2008) found a positive correlation between MSPQ scores and aphysiologic (i.e., non-organic) computerized dynamic posturography sway patterns in a sample of 115 patients with complaints of vestibular dysfunction and hearing impairment.…”

Somatization, secondary gain, and chronic pain: Is there a relationship?

“…A high percentage of CPPs demonstrate elevated hypochondriasis scores [22] and somatization scores [23] as measured by the Illness Behavior Questionnaire and the Modified Somatic Perceptions Questionnaire, respectively. In addition, when patients with various types of chronic pain are compared with appropriate controls on somatization measures, the CPPs are frequently demonstrated to have greater somatization scores.…”

A Systematic Review of Pain Drawing Literature

“…Von Baeyer et al, 22 Sikorski et al, 24 Ginzburg, 25 Lindal and Uden, 26 Greenough, 13 and Hagg et al 5 concluded that the relationship between pain drawings and the emotional states they tested were too weak to be clinically useful. We have methodologic and statistical concerns with Sivik's 7,15 and Ransford's 1 papers, which leaves little evidence to support pain drawings as predictors of psychologic state.…”