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The purpose of this study was to describe the associations between physical fitness and important aspects of chronic low back pain problems, specifically, pain, depression, physical dysfunction, and psychologic dysfunction. Ninety-six persons with chronic low back pain were evaluated with a battery of physical and psychologic disability measures and basic physical fitness tests for aerobic capacity, strength, and flexibility. Greater overall physical fitness was significantly correlated with less physical dysfunction (R = -0.48) and fewer depressive symptoms (multiple R = -0.42), but not with psychologic dysfunction (R = -0.20) or pain (R = -0.20). Fitness accounted for 23% of the variance in physical dysfunction and 17% of the variance in depression in this mildly dysfunctional chronic back pain patient sample. Strength, as compared with aerobic capacity or flexibility, was the fitness variable contributing most to these observed associations.
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PMID:Physical fitness and chronic low back pain. An analysis of the relationships among fitness, functional limitations, and depression. 296 88

In this prospective study, predictors of outcome were identified for patients (n = 116) who presented to their family physician with acute mechanical low back pain. Short-term outcome was measured by the number of days lost from work and longer term outcome was measured by disability at the six-week follow-up. Unlike other published work, this study did not find obesity or a history of previous back problems to be related to a poorer outcome from acute episodes of low back pain. Among those patients not involved in manual labor, a history of anxiety or depression was a significant predictor of both greater work loss and longer term disability. Among this same group, cigarette smoking was also found to be related to greater long-term disability from acute low back pain. Further study of this relationship is needed. The number of hours of manual labor performed daily was a strong predictor of poor outcome (both short- and long-term) of acute episodes of low back pain. Among both manual laborers and professional-technical workers, the number of days off work (at bed rest) prescribed by the physician was significantly related to greater absenteeism from work; the physician's diagnosis of an actual or possible disc problem was also related (P less than .05) to greater work loss among manual laborers. Neither of these factors, however, was related to longer term disability.
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PMID:Clinical predictors of outcome of acute episodes of low back pain. 297 13

This study investigated the relationship between stressful life events and depressed mood in chronic low back pain (CLBP), using both self-report and observer-rated assessments of life happenings and depression. We hypothesized that CLBP patients with depressed mood (N = 15) would report significantly more untoward life events and ongoing life difficulties compared to CLBP patients without depressed mood (N = 17) and controls (N = 19). This prediction was confirmed. Subjects also were rated as being either in a high stress or low stress condition. Patients with depressed mood were more likely to be in the high stress condition than were either non-depressed patients or volunteers. Furthermore, the increased stress reported by the distressed group appeared to be a direct consequence of back pain-related life events, rather than from other life problems. We conclude that previously reported associations between life events and CLBP are a function of the relationship between stressful life events and depressive symptoms, which are prevalent in CLBP.
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PMID:Depressed mood in chronic low back pain: relationship with stressful life events. 297 31

The present study explored the usefulness of the Minnesota Multiphasic Personality Inventory (MMPI) in understanding the relationship between duration of chronic pain and psychiatric difficulties. The MMPI responses of workers' compensation patients with varying levels of low back pain chronicity were compared. One hundred ninety eight patients, divided into three groups according to length of disability, underwent social history interviews and completed the MMPI. In regard to the overall profile, the sample had elevations on the Hypochondriasis, Depression, and Hysteria scales. A series of analysis of variance designs revealed that those who were disabled for two or more years evidenced significantly more depression and psychopathology than those who were disabled for less than one year. Further statistical evaluation of 200 social history variables did not reveal significant differences between the three groups on most variables. In conjunction with previous research, the results suggested a causative link between disability and psychiatric disease.
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PMID:Duration of chronic pain and the Minnesota Multiphasic Personality Inventory: profiles of industrially injured workers. 297 24

A treatment-outcome study was conducted to study the impact of behavior and physical therapy on components of the chronic low back pain syndrome. Eighteen patients received behavior therapy and 15 patients received physical therapy. All patients had at least a 6-month history of seeking treatment for chronic low back pain. Prior to treatment patients were assessed in four principal areas of functioning: (1) physical abilities; (2) current physical functioning; (3) psychological and psychosocial functioning; and (4) pain intensity and pain perception. Treatments were conducted in a group (five to eight patients) outpatient setting. Both behavior therapy and physical therapy groups met for 10-weekly sessions, each lasting 2 hr. Behavior therapy was designed to address the environmental, social, and emotional components of the low back pain syndrome as well as the depression and decreased activity that result from chronic low back pain. Physical therapy was based upon traditional rehabilitation theory and was designed to improve low back function. Patients were reevaluated at posttreatment, 6 months, and 1 year. The results showed a general improvement for patients in both groups and a few treatment-specific differences in outcome measures.
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PMID:Comparing physical and behavior therapy for chronic low back pain on physical abilities, psychological distress, and patients' perceptions. 315 99

The conversion 'V' is a familiar MMPI pattern which is traditionally used as a clinical marker of psychogenic pain. The 'V' form is assumed to arise because conversion suppresses depression thereby lowering scores on scale D, and exacerbates physical sensations thereby increasing scores on Hs and Hy. An inverse relationship between scales Hs and Hy, and D is therefore expected. These assumptions were tested in 102 patients with low back pain and organic findings, and 93 patients with non-organic findings. The pattern of correlation among the three scales did not distinguish organic patients from non-organic patients in which conversion is assumed to account for pain. Scale D was not inversely related to scales Hs and Hy in the non-organic group as expected from theory. The findings do not support the use of the conversion 'V' as a clinical marker.
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PMID:The value of the MMPI conversion 'V' in the assessment of psychogenic pain. 315 88

The relationship between anxiety and chronic pain has been poorly studied. The authors studied the occurrence of symptoms of anxiety in chronic low back pain patients. Anxious mood and other symptoms of anxiety were commonly seen in patients with chronic low back pain. Symptoms of anxiety were more common in patients with depression, especially those with major depression. Anxious mood, tension and general somatic symptoms of the sensory type were more common than any other type of anxiety symptoms. The authors discuss the potential role of anxiety in chronic pain patients.
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PMID:Chronic pain and depression. II. Symptoms of anxiety in chronic low back pain patients and their relationship to subtypes of depression. 316 36

Stressors in the family and job environments have been proposed to play a role in the modulation of pain, yet direct empirical support for such a role is limited. The present study investigated the relationship between general stress, family and work environments (perceived social climate), psychological distress (anxiety, depression), and pain experience (sensory, affective, evaluative) in 33 ambulatory chronic low back pain (CLBP) subjects and 35 healthy controls matched for age, sex, socioeconomic status (SES), weight, and height. Results indicated that environmental stressors/social climate measures, including family conflict, family control, and general stress (Social Readjustment Rating Scale), were greater in the CLBP group. Distress measures were also higher in the CLBP group. Characteristics of the family and work environments were found to be more predictive of the affective and evaluative dimensions of pain. Increased family conflict was associated with increased distress and increased pain, while increased family independence was correlated with less distress and increased pain. Less peer cohesion, less physical comfort, and less job clarity were correlated with increased pain, but not distress. Work pressure was associated with decreased depression and less pain. These findings suggested the presence of both stress and operant mechanisms in the modulation of pain in the family, while operant and distraction mechanisms appear to characterize the relationship among work environment factors and pain.
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PMID:Environmental stressors and chronic low back pain: life events, family and work environment. 316 37

Although it has often been observed that chronic pain and depression are associated, there have been few systematic comparisons of chronic pain patients with and without depression. In the study reported in this article, depressed and non-depressed chronic pain patients were found to be quite similar with respect to demographic, pain-related, and treatment response variables. The primary aim of the study, however, was to examine the hypothesis that treatment response in these two groups of patients would be predicted by different patterns of variables. In non-depressed patients, beneficial response to treatment was related to a greater number of treatment visits, not receiving workmen's compensation, fewer previous types of treatment, and low back pain. As predicted, a different pattern of predictors of treatment response was found for the depressed patients, who were more likely to benefit when they were employed at the beginning of treatment and when their pain was of shorter duration. These results suggest that activity and active involvement in treatment are particularly important with chronic pain patients who are depressed. In addition, they suggest that the best prediction of treatment response in future research on chronic pain patients may be achieved by dividing patients into groups based on psychological characteristics.
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PMID:Predicting treatment response in depressed and non-depressed chronic pain patients. 396 May 75

In a double-blind study, 67 chronic low back pain patients received 4 lumbar sympathetic nerve blocks, two given with bupivacaine and two given with saline. It was hypothesized that patients showing evidence of 'learned helplessness,' as measured by dependence on habit-forming medications for the pain, low activity levels, and elevated MMPI scores on Hypochondriasis, Depression and Hysteria would show the least reduction in subjective pain intensity following injections with both bupivacaine and saline. It also was hypothesized that placebo responses would be greatest in patients who had a high educational level, were divorced, and had no pending disability claims. Responses 30 min following nerve blocks failed to correlate with these variables. However, decreases in subjective pain intensity 24 h following both types of nerve blocks were greater in patients who showed low levels of pain behavior, who were divorced, and who had no pending disability claims. Decreased pain 24 h following saline injections was significantly related to low scores on the Lie, Defensiveness, Hypochondriasis, and Hysteria scales of the MMPI and to reduced subjective pain intensity following a 6 week comprehensive outpatient pain rehabilitation program. It was concluded that chronic pain patients who are fixed in their focus on pain, high in pain-related behaviors, and low in responsibilities are less likely to respond favorably to nerve blocks and that medical treatment for them needs to be paired with therapies designed to reduce their helplessness.
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PMID:Learned helplessness and responses to nerve blocks in chronic low back pain patients. 613 4


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