• R Schors and N Köppelmann.
• Abteilung für Psychosomatische Medizin und Psychotherapie, Städtisches Krankenhaus München-Bogenhausen, Englschalkinger Straße 77, W-8000, München 81, Bundesrepublik Deutschland.
• Schmerz. 1992 Jun 1;6(2):110-20.

AbstractIn a retrospective, controlled clinical study the life events of 35 patients suffering from chronic low back pain (LBP) and a matched sample of 23 patients with neurotic depression (ICD 300.4) were investigated. The pain patients formed two groups: 19 patients with definite organic diagnosis (IASP code 530.96) and 16 without (adequate) organic lesion (IASP code 510.99). Somatic diseases (other than LBP), injuries and operations, as well as psychic trauma (feelings of shame, narcissistic traumatisations and object losses) were defined and counted as documented in the patient's histories. Their distribution over the period between the 10th year before onset of LBP resp. depression and the 10th year after onset was calculated. As a result all patients have to cope with a maximum of stressful life events in the initial year of their disease. Those patients, who fell ill younger than 30 years old, are confronted with an increased number of stressful life events even during several years before the onset. In all groups significant more stress is experienced after illness onset compared with the time before onset. LBP patients without organic findings experience more narcissistic traumatisations than the other two groups in the initial year and later on. In contrast depressive patients suffer from more other diseases, injuries and have undergone more operations than pain patients throughout the whole time investigated. Object losses occur equally often in all groups, apart from the initial year, when depressive patients have to cope with even more losses than the others. These results are discussed considering the development of chronic pain syndromes, the influence of age and their consequences for models of illness. There is convincing evidence, that physical injury is neither a necessary nor a sufficient condition for the development of chronic pain and that chronic pain is in essence an emotional disease based on unresolved unconscious conflicts requiring psychotherapy.

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