|
| State
Of Mind May Influence Lower Back Pain |
NEW YORK (Reuters
Health) Is back pain actually all in the head?
New study
findings suggest that while back pain sufferers
do indeed have a debilitating physical ailment,
for many people there may also be a psychological
dimension associated with the presence, degree,
and duration of lower back pain.
Lower back pain has many causes, from relatively
minor such as muscle sprain to more serious, such
as a fracture or problem with a disc the cushioning
pad between the bones of the spine. "I'm not
saying back pain isn't real very few people have
back pain for absolutely no reason but we found
that of the people who have tears in their discs,
some manage well with it and some manage poorly
with it," said Dr. Eugene Carragee, study lead
author and associate professor of functional restoration
at the Stanford University Medical Center in California.
The study results are to be published in the December
issue of the journal Spine, and have already been
awarded the 1999 Volvo Corporation Award for the
Clinical Study of Low Back Pain an international
award for research that has a fundamental impact
on lower back healthcare.
Carragee and his team compared the results of magnetic
resonance images and vertebral disc tear tests among
96 patients who had known risk factors for disc
degeneration. Such tears have traditionally been
thought to directly cause lower back pain, with
ruptures in the discs that cushion contact between
the vertebra bones resulting in painful pressure
being placed on sensitive nerves. However, the researchers
were surprised to find that those patients with
disc problems were only slightly more likely to
have back pain then those without any disc degeneration.
They also noted that 25% of those who did have disc
problems had no lower back pain at all. Carragee
and his colleagues concluded that torn discs are
not always painful, and not all lower back pain
is a result of a torn disc.
From psychological tests, the researchers also
found that pain is actually more accurately associated
with the patient's state of mind with depression
and poor coping skills often being a better predictor
of back pain than disc damage. The researchers therefore
cautioned that treating a patient for emotional
and perceptual concerns may be more beneficial in
reducing lower back pain than the more standard
invasive, costly, and oftentimes unsuccessful back
fusion surgery option.
In an interview with Reuters Health, Carragee said
that pre-existing psychological problems seem to
have a clear relationship with both the onset of
lower back pain and the manner in which it is managed.
"Those people who suffered from depression
or an over-reaction to pain or fear of being hurt
reported a lot more pain," he noted. "If
someone has a tendency to hyperbolize whatever problems
they have like headaches when they do get a back
pain episode they really cope with it very badly.
There are some people who, when they hurt, will
try and stay in as good shape as possible and in
most of those people the pain will go away. And
that's the normal course of back pain for 85% of
the people. It will go away in a matter of a few
weeks. But for the others, they get into a real
cycle of getting more disabled, getting more pain,
getting more discouraged, and 2 years go by and
those people can become a real wreck."
Reemphasizing that he in no way wanted to indicate
that back pain is somehow not a real physical problem
with physical roots and physical solutions, Carragee
suggested that for some people addressing the psychological
dimension could help reduce the pain and quicken
relief. "The best thing for them and their
physicians is to work towards taking away the stigma
of their having a serious pathology in their back,"
he said. "It would be easier to help them and
get them going. It's mentally hard to get someone
to rehabilitate if they think they have a serious
mechanical problem in their back. And if people
are depressed, confronting whatever those issues
are head-on could help as well."
|
