A description of the psychological effects of chronic painful lesions

Abstract

The social adjustment and psychological characteristics of a group of patients with lesions presumed to be representative of an ‘ordinary’ pain clinic population have been examined. As expected there was a significant degree of disturbance of work, sleep, sport, exercise, leisure and social activities and sexual relationships. Patients with back pain found sitting to be particularly troublesome ( P < 0.0001) which suggests that they would have physical reasons for responding to programmes emphasizing ‘activity.’ They used more affective words proportionately to describe it than those with pain elsewhere, but both groups used far more sensory words overall than affective ones. Formal depression of the type measured by the Levine-Pilowsky Depression Questionnaire which corresponds to the psychiatric interview was not prominent. On the SCL-90, a more widely ranging type of psychological test, there were marked elevations on the somatization scale which are partly artifact, and also significant elevations for obsessive traits, depression, anxiety and general symptoms. Questions in the tests concerning irritability and frustration were frequently answered affirmatively. Low-back pain patients and compensation patients did not differ significantly from the remainder on the SCL-90 or on the Levine-Pilowsky Questionnaire. The findings are taken to indicate an understandable pattern of emotional response to chronic pain whether in the low back or elsewhere, as well as a specific difference in descriptions in patients with low-back pain. They are held to support the view that many patients receiving compensation have the same pattern of emotional response as those who do not obtain financial payment because of their illness.