Distress Linked to Back Pain Intensity

Psychiatric disorders play a role in chronic pain intensity

(RxWiki News) Don't discount the role of psychiatric disorders in chronic back pain. Distress may increase the pain intensity and inability to work when it comes to acute low back pain and chronic musculoskeletal pain.

Identifying distress early on and encouraging patients to stay active, however, may prevent pain-related disability.

Patricia Olaya-Contreras, a researcher from the department of orthopaedics at the Institute of Clinical Sciences at Sahlgrenska Academy, a part of Sweden's University of Gothenburg, found that patients with depressed mood who were advised to “adjust pain” showed worse pain-related disability over time. However when patients are advised to "stay active," they remained more physically active.

"Stay physically active to reduce pain."

During the initial phase of the study 174 patients on long-term sick leave with chronic musculoskeletal pain received an orthopaedic assessment and an evaluation of their ability to work. Of those patients, who had been referred to the evaluation by the Social Insurance Office, 83 also were sent for a psychiatric evaluation.

Researchers found that 27 percent of patients showed distress, and also greater pain and longer sick leave. They also discovered that neck pain was the main cause of disability and that 84 percent of patients were able to return to work to some degree.

However, unrecognized psychiatric disorders such as distress remained the main cause of inability to work in 69 percent of patients who were evaluated.

In another phase of the study, a randomized clinical trial involving 109 patients with acute low back pain was performed with the treatment advice “stay active” or “adjust activity” in order to assess the influence of distress on pain-related disability and physical activity during seven days of follow up.

Investigators found that pain-related disability decreased in all patients, but patients told to "adjust pain" showed worse disability over time, while the other group was more likely to comply and also remained more active.

The clinical study was recently published in the Clinical Journal of Pain.

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Review Date: 
September 22, 2011