title: Severe unexplained loin pain (loin pain haematuria syndrome): management and long-term outcome.
abstract: BACKGROUND
  The intractable and unexplained loin pain of severe 'loin pain haematuria syndrome' (LPHS) causes great psychosocial distress and disability.
  
  
  OBJECTIVE
  To examine the psychological factors in LPHS patients who had failed to respond to non-opiate analgesia, and explore the feasibility of conservative management.
  
  
  METHODS
  Retrospective review of case notes, medical and GP records, with follow up.
  
  
  METHODS
  We studied 21 consecutive patients referred from specialist renal centres to a regional pain clinic. All records were reviewed, and patients received a comprehensive psychiatric and social assessment. Medication with pain-coping strategies was emphasized, and surgical solutions were discouraged.
  
  
  RESULTS
  Patients' median age was 43 years (range 21-64) and duration of symptoms 11 (1-34) years. Sixteen were receiving opiates, and none had enduring benefit from surgery. Patients were divisible into three groups: twelve (57%) gave a history of recurrent, unexplained symptoms involving other parts of the body (somatoform disorder); seven had chronic loin pain; dissimulation was suspected in two. At follow-up (median 42 months), eight (38%) rated their pain absent or improved. Of the 11 whose pain was the same or worse, all were on opiates and seven had a somatoform disorder. A further two patients had developed 'other' medical problems. Despite our advice, three patients underwent major surgery for pain.
  
  
  CONCLUSIONS
  We recommend that patients be managed in a regional pain clinic, where a multidisciplinary approach promotes self-management of pain. Patients who were able to accept conservative treatment, and taper or withdraw opiate analgesia, had a better prognosis.
authors.affiliation: Department of Psychological Medicine, John Radcliffe Hospital, Oxford OX3 9DU. christopher.bass@obmh.nhs.uk
authors.forename: C M
authors.initials: CM
authors.lastname: Bass
authors.forename: H
authors.initials: H
authors.lastname: Parrott
authors.forename: T
authors.initials: T
authors.lastname: Jack
authors.forename: A
authors.initials: A
authors.lastname: Baranowski
authors.forename: G H
authors.initials: GH
authors.lastname: Neild
mesh_terms: D000293:Adolescent; D000328:Adult; D005240:Feasibility Studies; D005260:Female; D021501:Flank Pain / Q000209:etiology* / Q000628:therapy; D005500:Follow-Up Studies; D006417:Hematuria / Q000150:complications* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010148:Intractable Pain / Q000209:etiology* / Q000628:therapy; D010348:Patient Care Team; D011569:Psychiatric Status Rating Scales; D011584:Psychology; D013001:Somatoform Disorders / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology; D016896:Treatment Outcome