Idea Chronic Pain Is Psychological Dispelled by Recent Studies

Several studies presented at the International Association for Study of Pain at Montreal 2010, all find the association of psychological problems and Chronic pain to be weak.

OVERLOOKING 4 STUDIES INTO THE RELATIONSHIP BETWEEN PSYCHOLOGICAL FACTORS AND DISABILITY IN PATIENTS WITH CHRONIC LOW BACK PAIN: CONSISTENT AND REMARKABLE OUTCOMES
H. R. Schiphorst Preuper^1,2, M. F. Reneman^1,2, A. M. Boonstra³, P. U. Dijkstra^4,2, J. H. Geertzen^5,2, ¹Ctr. for Rehabilitation, Univ. Med. Ctr. Groningen, Haren, Netherlands, ²Share, Univ. Med. Ctr. Groningen, Groningen, Netherlands, ³Revalidatie Friesland, Beetsterzwaag, Netherlands, ⁴Dept. of Oral and Maxillofacial Surgery, Univ. Med. Ctr. Groningen, Groningen, Netherlands, ⁵Ctr. for Rehabilitation, Univ. Med. Ctr. Groningen, Groningen, Netherlands
IASP Poster PT 036

They refer to 4 studies:

1) Spine J. 2007 Sep-Oct;7(5):525-30. Epub 2006 Dec 22.
The relationship between psychosocial distress and disability assessed by the
Symptom Checklist-90-Revised and Roland Morris Disability Questionnaire in
patients with chronic low back pain
Schiphorst Preuper HR, Reneman MF, Boonstra AM, Dijkstra PU, Versteegen GJ,
Geertzen JH.  abstract here
“CONCLUSION: The relationship between psychosocial distress measured with the SCL-90-R and self-reported disability measured with the RMDQ in CLBP [Chronic low back pain] patients is weak.”

2) Eur Spine J. 2008 Nov;17(11):1448-56. Epub 2008 Sep 16.
Relationship between psychological factors and performance-based and self-reported disability in chronic low back pain.
Schiphorst Preuper HR, Reneman MF, Boonstra AM, Dijkstra PU, Versteegen GJ, Geertzen JH, Brouwer S.     free article here
“The suggested strong relationship between psychological factors and performance-based and self-reported disability in CLBP could not be confirmed in this study.”

3)J Occup Rehabil. 2007 Jun;17(2):247-58. Epub 2007 Mar 13.
Are pain intensity and pain related fear related to functional capacity evaluation performances of patients with chronic low back pain?
Reneman MF, Schiphorts Preuper HR, Kleen M, Geertzen JH, Dijkstra PU.  free article here
“CONCLUSIONS: The relation between pain and pain related fear and FCE performance is weak or non-existent in patients with CLBP.”

4)Patient Characteristics and relationships between pain, psychosocial distress and self reported disability in chronic low back pain patients in 6 rehabilitation centers in the Netherlands. HR Schiphorst Preuper et al
Spine in press
“The strength of the relationships between psychological factors and disability in patients with CLBP was consistently nonsignificant or weak. Pain intensity was consistently stronger related to disability than psychological variables.”

Their conclusion – Consider stronger and more consistent relationship between pain and disability in biopsychosocial model.

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IS IT ALL IN MY MIND ? PSYCHOGENIC PAIN REVISITED
M. Malafronte¹, G. De Benedittis²
IASP poster PH 060. Montreal 2010

• out of 5318 cases, 2.1 % received a diagnosis of somatiform disorder
• Conclusion – Psychogenic Pain is a rather rare (2%), and poorly understood, painful condition.

The poor association of somatoform symptoms with psycholgical origins has lead Dr. Merskey to write:

Pain. 2009 Sep;145(1-2):4-5. Epub 2009 May 22.
Somatization: or another God that failed.
Merskey H.

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PSYCHOLOGICAL FACTORS ARE NOT RELATED TO ACTIVITY LEVEL IN PATIENTS WITH CHRONIC MUSCULOSKELETAL PAIN.
M. Helmus¹, H. R. Schiphorst Preuper^1,2, J. H. Geertzen^1,2, A. L. Hof^1,3, M. F. Reneman^1,2, ¹Rehabilitation medicine, UMCG, Groningen, Netherlands, ²Graduate Sch. of Med. Sci., UMCG, Groningen, Netherlands, ³Ctr. for Human Movement Sci., UMCG, Groningen, Netherlands

•  “Activity level was measured by the RT3-accelerometer during one week.”
• “Conclusions: The relationship between psychological factors and activity level in patients with CMP was non-existing or weak.”

Some years ago, the wife of a police officer was told because her MRI was normal, her neck pains must be all in her head – and that excuse was used to terminate her nursing WCB injury claim. Given that 65% of neck pains are facet and they do not show on imaging, that is just plain fraud.

Now it appears that contending that is it primarily a psychological issue when pain severity appears to be the driving force, is fraud as well.

If you are a chronic pain sufferer, I would suggest this note be printed for your case worker who may have a toxic attitude problem.

Any opinions?