Articles: low-back-pain.
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We report the case of a ten year old female student who complained of chronic back pain and morning stiffness of several months duration. She failed to respond to non-steroidal anti-inflammatory drugs (NSAIDS). Further investigations which included bone and CT scan revealed the presence of an osteoid osteoma at the first sacral vertebra (S1 vertebra). The patient made an excellent recovery after surgical excision.
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A consecutive series of 98 patients presenting at an orthopedic outpatient clinic with chronic low back pain of at least 6 months' duration and with no organic findings (ruled out by clinical and radiological examination) were evaluated by means of a questionnaire which included the constructs "patient history," "pain-related restrictions," and "depression." Pain perception was evaluated with an adjective list revealing four main factors: two affective factors, i.e., "suffering from pain" and "anxiety," and two sensory factors, i.e., "acuteness" and "rhythmics of pain." The two affective factors (as against the sensory factors) subsequently influence the degree of pain intensity (measured with a visual analog scale), the patient's history and the patient's perceived impairment of daily life. Depression (von Zerssen scale) correlated with pain factors only when the whole range of pain factors was considered. The implications for treatment in patients with a high score for affective factors in the adjective list (indicator for a low success rate with traditional therapy) are discussed.
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Psychodynamic concepts postulate a psychogenesis of physical pain proposing several assumptions about the conversion of mental suffering into physical pain. Behavioural concepts, on the other hand, emphasize psychological conditions as risk factors for chronicity and describe psychological reactions to chronic pain. Patients with painful diseases and inadequate coping strategies very often display symptoms of anger, anxiety, or depression. ⋯ Subjects included in the study were given diagnoses of low back pain, tension headache, rheumatoid arthritis, and ankylosing spondylitis. Treatment effects in different diagnostic groups were compared to each other, supporting the assumption that pain reduction is greatest in low back pain and least in ankylosing spondylitis. Subjects with inflammatory rheumatic diseases showed some improvement in self-reported physical complaints and in their feelings of well-being.
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Despite all of the progress that has been made in diagnostic procedures and the increasing number of treatment facilities available the number of people suffering from chronic pain conditions seems to be growing constantly in all industrialized countries, a fact which is demonstrated impressively by the epidemiology of low back pain. "Chronic" means "life-determining"-chronic pain, as all chronic illnesses represent a turning point in the life situation of the people concerned. They not only affect the patients, but also the members of their immediate social environment. Chronic pain becomes a destructive stigma when society reduces the afflicted persons to the status of the chronically ill. ⋯ The introduction of the concept of the "healthy pain patient" has the goal of raising the competence of the individual and his/her social environment to improve the quality of life in spite of chronic pain. The educational aim is to enable patients with pain to be autonomous and to maximize their potential health. The therapeutic approach is demonstrated by individual case histories.
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Treatment of chronic low back pain (CLBP) is not only expensive, but is frequently not totally effective. For these reasons, it is important that the risk factors that correlate with the development of chronic pain be considered at the early stage of acute low-back pain (ALBP) in order to implement early treatment to prevent the condition from becoming chronic. ⋯ In light of the need to contain costs, a program for the prevention of chronic back pain can only be provided for those ALBP patients with an increased risk of having CLBP. Further research on the prevention on CLBP is needed.