Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Psychological factors may be root of back pain, say Stanford researchers

17.05.2004


When it comes to back pain, psychological distress is a more reliable predictor of the problem than imaging and diagnostic disc injection, Stanford University School of Medicine researchers say. Their finding could affect how doctors treat back pain, which often includes costly surgery that insurance companies are increasingly reluctant to cover.



Most adults in the United States will experience disabling lower back pain at least once in their lives, but their doctors frequently can’t find a specific physical cause. In a four-year investigation that followed patients who initially had no lower back pain, researchers studied their subjects’ spines using both disc injection and magnetic resonance imaging, or MRI. And they also got to know their research subjects through psychological evaluations. It turned out that psychological factors more accurately predicted who would develop lower back pain than the two diagnostic techniques.

In people both with and without back pain, MRI can detect cracks or tears in the spongy cartilage disc that cushions each unit of the spine. Some doctors also have suggested that if a patient feels pain when fluid is injected into one of the spine’s discs in a procedure called discography, the patient will soon develop back pain even if he or she doesn’t already feel discomfort.


"It was thought that discography could separate the wheat from the chaff," said Eugene Carragee, MD, professor of orthopedic surgery and lead author of the study, which is published in the May 15 issue of Spine. "But the bottom line is that it didn’t predict who would go on to develop back pain." Carragee and colleagues also found that the invasive discography procedure itself does not injure the spinal disc enough to cause back pain.

Carragee and his team examined 46 discography subjects and 49 control individuals annually over the four-year study period. Some of them had undergone cervical surgery or had been diagnosed with chronic pain syndrome, but none had lower back pain at the start of the study. "Nobody had ever followed a high-risk, asymptomatic group with discography or MRI for such a long period," said Carragee, who also directs Stanford’s Orthopedic Spine Center.

The researchers found that patients with poor coping skills - as measured by psychological testing - or with chronic pain were nearly three times more likely to develop back pain compared to those with neither. A history of disputed workers’ compensation claims also predicted future back pain. Meanwhile, a crack in the disc or a "high-intensity zone" seen on MRI was weakly associated with back pain, but the result was not statistically significant. "The structural problems were really overwhelmed by the psychosocial factors," Carragee said.

Some insurance companies and state workers’ compensation funds are already balking at paying for surgery to treat nonspecific back pain associated with psychosocial problems, he noted. Only a quarter of the 300,000 spinal fusion operations that occur each year are done for obvious reasons, such as tumors, infections or deformities, and just a fraction of the rest - those with pain and ordinary age-related degeneration - have good results from the surgery.

"The question is, can we better identify groups that have a greater chance of being helped by surgery?" Carragee asked. It may be more appropriate to treat other patients by helping them cope with the pain and strengthening their backs, he suggested.

He and his Stanford co-authors, who include Babak Barcohane, MD, Todd Alamin, MD, and Erica van den Haak, are working on a companion five-year study to examine a higher-risk group: patients who already have common lower back pain.

Michelle Brandt | EurekAlert!
Further information:
http://med-www.stanford.edu/MedCenter/MedSchool/

More articles from Health and Medicine:

nachricht Inhaling air pollution-like irritant alters defensive heart-lung reflex for hypertension
19.06.2019 | University of South Florida (USF Innovation)

nachricht Nitric oxide-scavenging hydrogel developed for rheumatoid arthritis treatment
06.06.2019 | Pohang University of Science & Technology (POSTECH)

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Successfully Tested in Praxis: Bidirectional Sensor Technology Optimizes Laser Material Deposition

The quality of additively manufactured components depends not only on the manufacturing process, but also on the inline process control. The process control ensures a reliable coating process because it detects deviations from the target geometry immediately. At LASER World of PHOTONICS 2019, the Fraunhofer Institute for Laser Technology ILT will be demonstrating how well bi-directional sensor technology can already be used for Laser Material Deposition (LMD) in combination with commercial optics at booth A2.431.

Fraunhofer ILT has been developing optical sensor technology specifically for production measurement technology for around 10 years. In particular, its »bd-1«...

Im Focus: The hidden structure of the periodic system

The well-known representation of chemical elements is just one example of how objects can be arranged and classified

The periodic table of elements that most chemistry books depict is only one special case. This tabular overview of the chemical elements, which goes back to...

Im Focus: MPSD team discovers light-induced ferroelectricity in strontium titanate

Light can be used not only to measure materials’ properties, but also to change them. Especially interesting are those cases in which the function of a material can be modified, such as its ability to conduct electricity or to store information in its magnetic state. A team led by Andrea Cavalleri from the Max Planck Institute for the Structure and Dynamics of Matter in Hamburg used terahertz frequency light pulses to transform a non-ferroelectric material into a ferroelectric one.

Ferroelectricity is a state in which the constituent lattice “looks” in one specific direction, forming a macroscopic electrical polarisation. The ability to...

Im Focus: Determining the Earth’s gravity field more accurately than ever before

Researchers at TU Graz calculate the most accurate gravity field determination of the Earth using 1.16 billion satellite measurements. This yields valuable knowledge for climate research.

The Earth’s gravity fluctuates from place to place. Geodesists use this phenomenon to observe geodynamic and climatological processes. Using...

Im Focus: Tube anemone has the largest animal mitochondrial genome ever sequenced

Discovery by Brazilian and US researchers could change the classification of two species, which appear more akin to jellyfish than was thought.

The tube anemone Isarachnanthus nocturnus is only 15 cm long but has the largest mitochondrial genome of any animal sequenced to date, with 80,923 base pairs....

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

SEMANTiCS 2019 brings together industry leaders and data scientists in Karlsruhe

29.04.2019 | Event News

Revered mathematicians and computer scientists converge with 200 young researchers in Heidelberg!

17.04.2019 | Event News

First dust conference in the Central Asian part of the earth’s dust belt

15.04.2019 | Event News

 
Latest News

A new manufacturing process for aluminum alloys

19.06.2019 | Materials Sciences

Inhaling air pollution-like irritant alters defensive heart-lung reflex for hypertension

19.06.2019 | Health and Medicine

Innovative powder revolutionises 3D metal printing

19.06.2019 | Materials Sciences

VideoLinks
Science & Research
Overview of more VideoLinks >>>