Predicting outcome of chronic back pain using clinical predictors of psychopathology: a prospective analysis.

This study evaluated whether a comprehensive assessment of psychosocial measures is useful in characterizing those acute low back pain patients who subsequently develop chronic pain disability problems. A cohort of 324 patients was evaluated, with all patients being administered a standard battery psychological assessment tests. A structured telephone interview was conducted 6 months after the psychological assessment to evaluate return-to-work status. Analyses, conducted to differentiate between those patients who were back at work at 6 months versus those who were not because of the original back injury, revealed the importance of 3 measures: self-reported pain and disability, the presence of a personality disorder, and scores on Scale 3 of the Minnesota Multiphasic Personality Inventory. These results demonstrate the presence of a psychosocial disability variable that is associated with those injured workers who are likely to develop chronic disability problems.

Prevalence of psychopathology in carpal tunnel syndrome patients.

This study assessed the prevalence rates of psychopathology in acute carpal tunnel syndrome (CTS) and acute low back pain (LBP) patients. Psychopathology was assessed with the Structured Clinical Interview for the DSM-III-R (SCID). The results showed that the CTS patients had significantly higher rates of anxiety disorders, both current and lifetime, than the LBP patients. However, LBP patients had significantly higher rates of lifetime substance abuse than the CTS patients. In regard to other types of psychopathology, such as depression, current substance abuse, and somatoform pain disorders, CTS patients had similar rates as the LBP patients. It was concluded that anxiety disorders may be a concomitant of carpal tunnel syndrome, and that treating psychological problems along with physical aspects of the syndrome may increase the patient's chance of a successful therapeutic outcome.

Psychiatric illness and chronic low-back pain. The mind and the spine--which goes first?

Two hundred chronic low-back pain patients entering a functional restoration program were assessed for current and lifetime psychiatric syndromes using a structured psychiatric interview to make DSM-III-R diagnoses. Results showed that, even when the somewhat controversial category of somatoform pain disorder was excluded, 77% of patients met lifetime diagnostic criteria and 59% demonstrated current symptoms for at least one psychiatric diagnosis. The most common of these were major depression, substance abuse, and anxiety disorders. In addition, 51% met criteria for at least one personality disorder. All of the prevalence rates were significantly greater than the base rate for the general population. Finally, and most importantly, of these patients with a positive lifetime history for psychiatric syndromes, 54% of those with depression, 94% of those with substance abuse, and 95% of those with anxiety disorders had experienced these syndromes before the onset of their back pain. These are the first results to indicate that certain psychiatric syndromes appear to precede chronic low-back pain (substance abuse and anxiety disorders), whereas others (specifically, major depression) develop either before or after the onset of chronic low-back pain. Such findings substantially add to our understanding of causality and predisposition in the relationship between psychiatric disorders and chronic low-back pain. They also clearly reveal that clinicians should be aware of potentially high rates of emotional distress syndromes in chronic low-back pain and enlist mental health professionals to help maximize treatment outcomes.

Prevalence of psychopathology in acute and chronic low back pain patients.

This study assessed the differential prevalence rates of psychopathology in chronic and acute low back pain patients. Psychopathology was assessed with the Structured Clinical Interview for the DSM-III-R (SCID). The results showed that chronic low back pain patients (n=90), had much higher rates of psychopathology than did patients in the acute back pain group (n=90), and much higher than general population base rates. In particular, chronic low back pain patients had high rates of major depression, substance abuse, and personality disorders. Moreover, the chronic low back patients also had high rates of premorbid psychopathology. It was concluded that psychopathology is a major concomitant of chronic low pack pain, and that treating the psychological problems, along with the physical aspects of the chronic low back pain may increase the patient's chance of a successful therapeutic outcome.

Major psychological disorders in chronic TMD patients: implications for successful management.

The authors assessed psychological disorders in 50 chronic TMD patients. These disorders appear to be a major concomitant factor in chronic TMD, and may need to be treated for successful outcomes.

The SCL-90R evaluated as an alternative to the MMPI for psychological screening of chronic low-back pain patients.

The efficacy of using the SCL-90R as an alternative measure to the MMPI in the psychological screening of chronic low-back pain (CLBP) patients was investigated. The MMPI and the SCL-90R were administered to 99 CLBP patients (63 men and 36 women) at the time of admission to a functional restoration treatment program. The SCL-90R was readministered after successful completion of the treatment program. Analyses indicated that there were significant changes on almost all SCL-90R clinical scales from pretreatment to post-treatment (P less than 0.01). Moreover, there were adequate levels of correlation between corresponding MMPI and SCL-90R scales (r ranged from 0.35 to 0.51). However, analyses of the interscale correlations of the SCL-90R indicated that it may be a single-factor instrument that assesses general psychological distress. It was suggested that the SCL-90R may be used as a screening device for psychological distress in CLBP patients, but if more detailed information about the patients' psychological condition is needed, the MMPI will be a more useful instrument.

Differentiation between somatic and cognitive/affective components in commonly used measurements of depression in patients with chronic low-back pain. Let's not mix apples and oranges.

Patients with chronic low-back pain are frequently diagnosed as depressed. However, many of the neurovegetative signs of depression may also result from pain. The purpose of the present study was 1) to investigate the relationship between commonly used measurements of depression and pain perception; and 2) to examine the utility of differentiating between somatic signs and cognitive/affective symptoms of depression in patients with chronic low-back pain. The Beck Depression Inventory and the Hamilton Psychiatric Rating Scale for Depression were divided into cognitive/affective and somatic subscales. These measures, as well as the Minnesota Multiphasic Personality Inventory, were administered to 111 patients with chronic low-back pain. Analyses revealed significant correlations between depression scores and self-reported pain intensity. The cognitive/affective subscale of the Beck Depression Inventory resulted in the only nonsignificant correlation with pain intensity. These findings suggest that commonly used measurements of depression are confounded with pain symptomatology and that the cognitive/affective category of the Beck Depression Inventory may prove to be a more accurate measurement of depression in patients with chronic low-back pain.

The functional restoration approach for chronic spinal disability.

The functional restoration approach to treating chronic spinal disability consists of a medically directed, interdisciplinary team approach to physical reconditioning and a cognitive-behavioral "crisis intervention" procedure for dealing with related psychosocial problems. One- and two-year follow-up studies have demonstrated the clinical efficacy of this approach. The present article describes this approach and summarizes the research documenting its success in treating patients with chronic spinal disability. This article also highlights the pitfalls in misunderstanding and misrepresenting the components of the functional restoration approach when evaluating treatment efficacy.