Chapter 016. Back and Neck Pain (Part 11) doc

Back and Neck Pain Part 11 Psychiatric Disease CLBP may be encountered in patients who seek financial compensation; in malingerers; or in those with concurrent substance abuse, chronic

Chapter 016 Back and Neck Pain

(Part 11)

Psychiatric Disease

CLBP may be encountered in patients who seek financial compensation; in malingerers; or in those with concurrent substance abuse, chronic anxiety states, or depression Many patients with CLBP have a history of psychiatric illness (depression, anxiety, substance abuse) or childhood trauma (physical or sexual abuse) that antedates the onset of back pain Preoperative psychological assessment has been used to exclude patients with marked psychological impairments that predict a poor surgical outcome

Unidentified

The cause of low back pain occasionally remains unclear Some patients have had multiple operations for disk disease but have persistent pain and disability The original indications for surgery may have been questionable, with back pain only, no definite neurologic signs, or a minor disk bulge noted on CT or

MRI Scoring systems based upon neurologic signs, psychological factors, physiologic studies, and imaging studies have been devised to minimize the likelihood of unsuccessful surgery.[newpage]

Back Pain: Treatment

Acute Low Back Pain (ALBP)

ALBP is defined as pain of <3 months' duration Full recovery can be expected in 85% of adults with ALBP without leg pain Most have purely

"mechanical" symptoms (i.e., pain that is aggravated by motion and relieved by rest)

Observational studies have been used to justify a minimalist approach to this problem These studies share a number of limitations: (1) a true placebo control group is often lacking; (2) patients who consult different provider groups (generalists, orthopedists, neurologists) are assumed to have similar etiologies for their back pain; (3) no information is provided about the details of treatment; and (4) no attempt to tabulate structural causes of ALBP is made

The algorithms for the treatment of back pain (Fig 16-6) draw from published clinical practice guidelines (CPGs) However, since CPGs are based on incomplete evidence, guidelines should not substitute for clinical judgment

Figure 16-6