Spine
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An unselected sample of outpatient subjects (n = 330) with localized nonspecific low back pain (LBP) was studied. Investigation consisted of clinical assessment, physical examination, and psychiatric interview based on the DSM-III classification. A psychiatric disorder, according to the DSM-III criteria (axis I) was found in 41% of the subjects. ⋯ Cluster analysis provided support for a four-group classification of low back pain, which may be interpreted through the relationships between psychological disturbances and the LBP clinical features. The results call for further investigation of the complex relationship between psychological disturbances and back pain. However, clinicians must be aware of the interest of a minimal psychiatric assessment in low back pain patients: psychiatric disorders frequently appear in these patients and an appropriate treatment of the psychiatric syndrome may reduce back pain.
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Most patients with chronic low back pain associate strenuous physical activities with increased pain. This association can cause avoidance of those activities believed to cause intolerable discomfort. This study explored the relationship of performance of physical activities with self-reported pain measures in 40 consecutive patients with disabling low back pain (mean duration 17 months) during a functional restoration rehabilitation program (mean treatment period 7 weeks). ⋯ At completion of treatment, significant improvement in performance on all physical tests was found, but these were not associated with consistent changes in pain measures. These results demonstrate that subjects with chronic low back pain can increase their physical performance abilities within their same pain experiences. Medical recommendations for subjects' involvement in physical activities should not be based solely on the reported association of pain with those activities.
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It has been proposed that pain treatment evaluation is hindered by heterogeneous properties of patient samples. Therefore, to facilitate pain treatment evaluation in this psychological study, a heterogeneous group of chronic low back pain patients was classified into more homogeneous subgroups. Two designs were used to compare the outcome by the "functioning activation" and the "spa resort" type of rehabilitation. ⋯ In the second design, the pain patient subgroups, homogenized by cluster analysis technique in accordance with the psychological profiles of functioning, were compared in their response to treatments. The results indicated that the outcome evaluation was facilitated by the latter design releasing more specific information about the effects of the program quality, the patient characteristics, and their interaction on the improvement by rehabilitation. It was concluded that in treatment outcome analysis, the subgroup's homogeneity must be considered.