• P Keel and C Calanchini.
• Psychiatrische Universitätspoliklinik Basel.
• Swiss Med Wkly. 1989 Jan 7; 119 (1): 22-31.

AbstractThe standardized interviews of 26 chronic back pain patients from central Europe (Switzerland, Germany, Poland) were compared with those of 28 patients from Mediterranean countries (Italy, Spain, Yugoslavia, Turkey), all of whom had been referred for participation in an integrated treatment program for chronic back pain. The two samples differed significantly in most of the psychosocial aspects studied. Patients from Mediterranean countries had a significantly lower level of education and were mostly employed as unskilled workers, while patients from central Europe were mostly housewives or skilled workers with higher levels of education. In the Mediterranean sample the back pain had generally developed much faster into a disabling disease with the attendant consequences (sick leave, loss of job, litigation). More than one third of the Mediterranean patients lived with a partner who was also sick and unable to work. These patients also adopted a more passive stance towards their illness by rarely using self-help, and showed poor readiness to participate in the self-monitoring orientated treatment program proposed to them. They were less aware of the influence of their own behaviour on pain and of any relation between the illness and their present or previous life situation. They complained less of a broken home in their childhood or earlier medical problems, but more frequently reported suffering from poverty in their childhood. The uneven composition of the two samples reflects the special social situation of foreign workers from Mediterranean countries in central Europe. Unskilled workers are significantly overrepresented in the latter segment of the adult working population of the study area (city of Basel, Switzerland). This overrepresentation is similar to that in our patient sample. The special situation of foreign workers from Mediterranean countries seems to account for their high incidence of chronic intractable back pain.

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