Correlates of Non-Physiological Behavior in Patients with Chronic Low Back Pain

Abstract

It is widely believed that the extent of a patient's subjective complaints are often based on developmental, psychological, social, and cultural factors rather than structural or physical pathology. In patients presenting with chronic low back pain, underlying behavioral problems may not be immediately apparent. These behavioral or non-physiological issues may be secondary to a deliberate deception or may be associated with psychological distress. Waddell et al developed a standardized assessment of behavioral or non-organic signs and symptoms in hopes that such an evaluation of the patient could lead to better utilization of surgical and diagnostic procedures. Multiple authors have described varying results correlating excessive pain behavior with psychological disorders. This study was designed to evaluate psychological correlates of pain behavior in 120 chronic low back pain patients in an interventional pain management setting with 60 men and 60 women. Patients were evaluated with completion of a physical examination, which included Waddell's non-physiological symptoms and signs, and psychological evaluation by Pain Patient Profile (P-3). Results showed that 27 patients (22%) presented with non-physiological symptoms, 34 patients (28%) with non-physiological signs, and 19 patients (16%) with combined presence of non-physiological signs and symptoms. Overall there was significant correlation of non-physiological signs with depression, anxiety, and somatization, both by diagnosis of depression, diagnosis of anxiety and elevated scores. However, correlation was present for non-physiological symptoms only with elevated scores of anxiety and somatization.