Psychological Factors in the Treatment of Chronic Low Back Pain

Abstract

The aim of the study was to investigate the role of certain psychological factors (e.g. neurotic features, alexithymia, and hostility) as intervening variables modifying the outcome of the back school intervention or correlating with spontaneous recovery. The results indicated that those patients who reacted favorably to the back school intervention could be described as emotionally well adjusted and controlled showing relatively good cognitive capacity with undisturbed reality testing. The poor responders in the treatment group were less capable cognitively and not so well balanced emotionally. Patients showing spontaneous recovery in the control group were characterized by a more lively and less controlled way of expressing emotions and affects. In contrast to these, patients who showed increasing disability during the 1-year follow-up were characterized by restricted expression of emotions and affects indicating alexithymia.

A Systematic Review of Sociodemographic, Physical, and Psychological Predictors of Multidisciplinary Rehabilitation—or, Back School Treatment Outcome in Patients With Chronic Low Back Pain

“…Of the 17 studies, 8 were RCT, 27,32,[57][58][59][60][61]65 and 9 were prognostic cohorts. 28,48,62-64,66 -69 Ten studies were classified as Phase I, 27,28,32,60 -63,66,67,69 and 7 as Phase II studies.…”

“…Five authors studied more than 9 variables, 57-60,65 with a maximum of 19 variables studied by Bendix et al 57 Sociodemographic variables were studied in 8 articles, 57-60,64 -66,68 physical variables in 7, 32,48,57,60 -63 and psychological variables in 10. 27,28,32,58,59,62,65,[67][68][69] Four articles studied "other " predictors, which includes baseline measurements of activity and participation limitation. [57][58][59]69 After classifying predictors into 3 main domains (i.e., sociodemographic, physical, and psychological), it was clear that none of the authors studied predictors from these 3 domains simultaneously.…”

Are difficulties perceiving and expressing emotions associated with low-back pain?

“…Recent studies found that patients with (mostly chronic) LBP suffer from a measurable deficit of proprioception, which can be seen as a subcategory of bbody-awarenessQ contributing to the clinical course of LBP [5][6][7][8][9][10]. Clinical studies suggested that these patients exhibit a deficit of emotional awareness as well [11][12][13][14][15][16]. For this unawareness of emotions, Sifneos et al [17] introduced in 1973 the term balexithymiaQ, literally (from Greek) no (a-) words (-lexi-) for feelings (-thymia).…”

“…Several studies examine the association between alexithymia and LBP [11][12][13][14][15][16]. Using the Thematic Apperception Test, 41 chronic LBP patients were independently evaluated for alexithymia by two clinicians; both evaluators agreed on alexithymia as one of the main features of these patients [15].…”

“…These four descriptive or cross-sectional studies show a positive association between alexithymia and LBP. However, the results of two prospective studies are inconsistent: One clinical trial among 175 Finnish patients with chronic LBP showed (comparing mean scores from the Rohrschach and the Sentence Completion Tests between good and poor responders by t test) that alexithymia played a hindering role in spontaneous recovery from chronic LBP during 1 year of follow-up; however, the study was limited to women [13]. On the other hand, a life-long prospective cohort study in Finland assessing alexithymia in 13-year-old children as lack of verbal productivity found no association with LBP in their adult life [16].…”