Diagnosis and treatment of patients with idiopathic back pain.
Tatjana Sivik
Abstract
Background. In order to decide upon the most suitable treatment for pain patients with different pain etiology instruments for differential diagnosis as well as appropriate knowledge are required.
Objectives. 1) To further study the hypothesis that many persons with a chronic idiopathic pain syndrome have specific personality traits which make them psychologically vulnerable. 2) To find simple and reliable diagnostic devices for an early identification of such riskpatients.3) To investigate the effects, on both doctors and their idiopathic pain patients, of a psychodynamically oriented therapeutic paradigm.
Main results:
Both chronically and acutely ill patients differed significantly from healthy controls in some specific personality traits - even though the acute patient group appeared less "pathologic".
Among the acutely ill back-pain patients could be identified individuals with a so-called "morbid personality" a trait which may predispose to chronic idiopathic pain.
A comparative analysis of the data lends support to the hypothesis that the destructive and morbid personality traits that characterize patients with chronic pains were already present at the onset of pain.
The main difference found between acutely and chronically ill pain patients was that the latter were more depressed and expressed the strongest denial of aggressive feelings.
The hypothesis about a specific personality structure of the pain-prone patient was supported by data from personality inventories as well as personality assessments based on projective TAT (Thematic Apperception Test) and a psychodynamic frame of reference.
In order to make the Patient Pain Drawing test (PPD) more useful for clinical purposes a simple, standardized scoring system was constructed which was shown to have satisfactory validity and reliability.
In a questionnaire survey, 57 general practitioners expressed dissatisfaction with their basic knowledge of psychosomatic diseases as wall as poor confidence in dealing with the psychological problems of their patients.
Six of these general practitioners participated in a five-year gaining programme in psychosomatic medicine which included the practice of psychotherapy under the supervision of the author. After the programme they reported that their knowledge and confidence, had improved considerably.
The patients who had received psychotherapeutic treatment by these six doctors were significantly more positive to the treatment than were a group of control patients who had undergone traditional treatment.
Key words: low-back pain; personality; psychological vulnerability; psychosocial factors; education; psychotherapeutic treatment.
ISBN 91-628-0580-0
Department of Primary Health Care, Göteborg University, Vasa Hospital, S-411 33 Göteborg, Sweden.