Clinical and psychological classification of non-specific low-back pain. A new study in primary care practice.
This study aimed to explore the clinical and psychological features of non-specific low-back pain (LBP), and to evaluate a classification of patients based on the relationship between psychological disturbances and LBP clinical presentation. An unselected population of consecutive patients (n = 262) complaining of low-back pain to primary care physicians of the Epidemiology Team of the French Rheumatology Society, in October and November 1991, was studied. Measures included a standardized clinical evaluation of the back and a psychological assessment using the General Health Questionnaire. Ninety nine patients (38%) were classified as having a psychological disorder. The following symptoms: psychological precipitating event, permanent pain at night, diffuse spinal pain, pain increased by changing climate, pain increased by psychological factors, dysesthesias in the back, non-anatomical tenderness, were found to be closely associated with the existence of psychological disorder. Correspondence and cluster analyses provided support for the four-group classification of low-back pain previously devised. This classification may be interpreted through the relationships between psychological disturbances and the back clinical features. Although the study was mainly descriptive and used a cross sectional design, its results underline the importance of psychological influence on low-back pain presentation, and suggest the interest of a psychiatric assessment in low-back pain patients. Psychological disorders appear to be frequent in these patients and specific management of these disorders may prove useful.
Coste
J
J
Service de rhumatologie, Hôpital Ambroise-Paré, Boulogne, France.
Schiano
P J
PJ
Leparc
J M
JM
Paolaggi
J B
JB
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000145:classification* / Q000175:diagnosis / Q000523:psychology; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis; D008875:Middle Aged; D015999:Multivariate Analysis; D011320:Primary Health Care; D011581:Psychological Tests; D011795:Surveys and Questionnaires