Back pain patients with mental illness may benefit from conservative treatments

Oct 5 2011
Conservative approaches to chronic lower back pain may be the best option for patients who are also coping with psychological problems, according to a new study published Oct. 1 in Spine.

Back pain may be the result of disease or injury to any of the structures protecting the spinal cord: the vertebrae, the facet joints that connect the bones and the intervertebral discs that act as shock absorbers and stabilize movement.

Both the vertebrae and facet joints can be affected by age-related degeneration, which may lead to the bones slipping and sliding against the spinal cord, according to the American Academy of Orthopaedic Surgeons (AAOS). This may cause a condition known as spondylolisthesis.

The discs are also vulnerable to mechanical wear and tear over time. A herniated disc occurs when one of these gel-filled structures ruptures or bulges out, putting pressure on the surrounding nerves and causing back pain that could radiate out to other parts of the body.

Back pain due to spinal stenosis occurs when parts of the spinal canal begin to narrow, which may be due to ligaments and bones that thicken as a response to osteoarthritis, the AAOS said.

About 80 percent of Americans are expected to have pack pain at some point in their lives. It is the leading neurological condition, second only to headaches. It can interfere with people's social interactions, work and other activities, according to the Centers for Disease Control and Prevention (CDC).

"Pain does not necessarily cause serious psychological distress, limitation of activity, or poor health status, but may interact with physical and mental health status to affect perceptions of pain, care-seeking behaviors, speed of recovery, and ability to function," the CDC wrote in a report.

Because of the interaction that pain could have with psychological disorders, a team of researchers wanted to see if there was a preferable type of treatment for patients with chronic lower back pain and a concurrent mental illness, such as depression, neuroticism or a personality disorder. The team reviewed past studies comparing conservative treatments to spinal fusion, a surgery that connects the vertebrae on either side of a herniated disc that has been removed.

The results of the review suggest that patients with a psychological disorder may benefit more from conservative approaches to chronic lower back pain, while those without a mental illness respond well to surgery. Doctors may want to screen patients for these mental conditions.

There are several non-surgical approaches to chronic lower back pain, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, a division of the National Institutes of Health. These include certain exercises, medications, pain injections and acupuncture.