Articles: back-pain.
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J Consult Clin Psychol · Apr 1988
Randomized Controlled Trial Comparative Study Clinical TrialComparison of operant behavioral and cognitive-behavioral group treatment for chronic low back pain.
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Back pain is a common condition and in most cases is not disabling. We have investigated disabling back pain that leads to health care utilization, time lost from work, and high costs. Disabling back pain remains of obscure origin because the focus in studying it has been too narrow. ⋯ Even though claimants of industrial insurance are employed, the unemployment rate was significantly related to the claim rate in the 3 years studied. Our interpretation is that disability is a symptom of distress. Where there is a rise in job insecurity and an attendant rise in economic insecurity, there is a greater likelihood that back pain will become disabling.
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Pain drawings were obtained from two groups of patients and one of nonpatients, in a total of 264 subjects, all suffering from back pain. The pain drawings were rated in four grades according to the degree of nonorganic and extended pain. ⋯ A correlation was also found to ethnic background and social situation but not to alcohol abuse or psychiatric illness. Pain drawings afford an important clue to nonorganic factors in the assessment of back pain.
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Adult patients with scoliosis often have back pain, but that pain may or may not be due to the curvature. A careful history, physical examination, routine radiographic examination, and, on some occasions, specialized radiographs, CT, myelography, discography, and facet joint injection will help the physician or surgeon separate out those pain syndromes owing to the curvature versus those not owing to the curvature. Only after these critical evaluations have been done can a decent decision be made as to the area of the spine to be treated, either surgically or nonsurgically.
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Chronic back pain patients were compared to two nonpain comparison groups on Minnesota Multiphasic Personality Inventory (MMPI) Hysteria (Hy) scores and scores on two Hy subscales: Bodily Concern and Psychological Denial. Pain subjects had significantly higher scores on the Bodily Concern Subscale and lower scores on the Psychological Denial Subscale than nonpain subjects with similar elevated Hy scores. ⋯ Finally, within pain patients, scores on the Bodily Concern subscale were significantly related to more indices of pain duration and severity than were scores on the Psychological Denial subscale. The potential clinical utility of scoring these subscales is discussed.