The use of the low back and the dorsal scales in the identification of functional low back patients

Abstract

Scores from the Low Back (Lb) and the Dorsal (DOR) scales of 20 patients with functional low back pain, 20 patients with functional gastrointestinal pain, and 20 psychoneurotic patients were compared. Among the various proposed cut-off scores, the Lb score of 11 yielded the highest rate (75%) of correct identification of Low Back patients and a hit rate similar to those reported in previous studies. However, it was noted that this 75% hit rate did not achieve statistical significance. Furthermore, the data indicated that neither the Lb nor the DOR scales could differentiate the Low Back patients from other psychosomatic and psychiatric patients and suggested that these two scales should be used with extreme caution by clinicians.

Comment on 'Personality Organization as an Aspect of Back Pain in a Medical Setting.'

“…Indeed, the lack of cross-validational support for the Lb scale prompted Pichot et al (1972) to develop the DOR scale of "functional" pain, Freeman, Calsyn, and Louks (1976) found that neither the Lb nor the DOR scale alone successfully discriminated "mixed" and "functional" LBP patients from "organic" patients; when both scales were used together, however, 75% of all LBP patients were correctly classified. Contrary to the results above, Towneand Tsushima(1978) found that the simultaneous use of the Lb and DOR scales failed to discriminate at more than a chance level "functional" LBP patients from patients with either (a) gastrointestinal complaints not fully substantiated by medicalevaluations, or (b) emotionalproblems. It was concluded that the Lb and DOR scales are not sensitive to responses that are unique to persons with "functional" back pain; instead, the scales appear to measure characteristics common to persons with back pain, psychoneurosis and questionable gastrointestinal disorders (Towne & Tsushima, 1978, p. 90).…”

“…Towne and Tsushima (1978) reported that although the successful discrimination of "functiona1"from"organic" LBP patients with the Lb scale originally reported by Hanvik (1951) was later replicated by Dahlstrom (1954), more recent evidence suggests that the validity of the Lb scale is questionable. Indeed, the lack of cross-validational support for the Lb scale prompted Pichot et al (1972) to develop the DOR scale of "functional" pain, Freeman, Calsyn, and Louks (1976) found that neither the Lb nor the DOR scale alone successfully discriminated "mixed" and "functional" LBP patients from "organic" patients; when both scales were used together, however, 75% of all LBP patients were correctly classified.…”

A further look at validity of the MMPI with low back patients

“…Moreover, a sizeable portion of their patients were diagnosed falsely as without physical findings and with undue disability. In view of our results and Towne andTsushima's (1978, 1979) failures to cross-validate the LB and DOR scales, clinicians are cautioned against making a diagnosis on the basis of these two scales alone.…”

Predicting Medical Test Results and Intra-Operative Findings in Chronic Pain Patients Using the On-Line “Pain Validity Test”

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Functional" pain is defined as a pain for which there is no organic pathology, while "organic" pain is defined as pain that does have a medical explanation. The MMPI had been used to differentiate between "organic" and "functional" groups of chronic back pain patients with varying degrees of accuracy [19][20][21], and specifically developed subtests of the MMPI were also unreliable [21][22][23]. One group of researchers tried to correlate Volume 5 Issue 1 -2016

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