Diagnosis and treatment of patients with idiopathic back pain.
Tatjana Sivik
Abstract
Background. In order to decide upon the most suitable treatment for pain patients with
different pain etiology instruments for differential diagnosis as well as appropriate knowledge
are required.
Objectives. 1) To further study the hypothesis that many persons with a chronic idiopathic pain
syndrome have specific personality traits which make them psychologically vulnerable. 2) To
find simple and reliable diagnostic devices for an early identification of such riskpatients.3) To
investigate the effects, on both doctors and their idiopathic pain patients, of a
psychodynamically oriented therapeutic paradigm.
Main results:
Both chronically and acutely ill patients differed significantly from healthy controls in some
specific personality traits - even though the acute patient group appeared less "pathologic".
Among the acutely ill back-pain patients could be identified individuals with a so-called
"morbid personality" a trait which may predispose to chronic idiopathic pain.
A comparative analysis of the data lends support to the hypothesis that the destructive and
morbid personality traits that characterize patients with chronic pains were already present at
the onset of pain.
The main difference found between acutely and chronically ill pain patients was that the latter
were more depressed and expressed the strongest denial of aggressive feelings.
The hypothesis about a specific personality structure of the pain-prone patient was supported
by data from personality inventories as well as personality assessments based on projective
TAT (Thematic Apperception Test) and a psychodynamic frame of reference.
In order to make the Patient Pain Drawing test (PPD) more useful for clinical purposes a
simple, standardized scoring system was constructed which was shown to have satisfactory
validity and reliability.
In a questionnaire survey, 57 general practitioners expressed dissatisfaction with their basic
knowledge of psychosomatic diseases as wall as poor confidence in dealing with the
psychological problems of their patients.
Six of these general practitioners participated in a five-year gaining programme in
psychosomatic medicine which included the practice of psychotherapy under the supervision
of the author. After the programme they reported that their knowledge and confidence, had
improved considerably.
The patients who had received psychotherapeutic treatment by these six doctors were
significantly more positive to the treatment than were a group of control patients who had
undergone traditional treatment.
Key words: low-back pain; personality; psychological vulnerability; psychosocial factors;
education; psychotherapeutic treatment.
ISBN 91-628-0580-0
Department of Primary Health Care, Göteborg University, Vasa Hospital, S-411 33 Göteborg,
Sweden.