Vert Mooney

A prospective short-term study of chronic low back pain patients utilizing novel objective functional measurement☆☆☆

&NA; The present study utilized recently developed diagnostic tests that permit recognition of functional deficits in spine mobility, trunk strength, endurance, coordination, and dynamic lifting capacity. Changes in these tests were compared to changes in psychological functioning (e.g., self‐report of pain) as well as to outcome criteria such as return‐to‐work and resolution of litigation. The study utilized these tests repeatedly during a new treatment approach to feed back objective information of the patients functional capacity, not amenable to simple visual inspection, to both the patient and the surgeon. The program itself integrated a low back physical rehabilitation program with a multimodal pain management program and was guided by repeated functional capacity measurements. A total of 66 patients were evaluated. Results demonstrated significant improvement in physical function in these patients, which was also accompanied by changes in self‐report of pain complaints. Moreover, an 82% return‐to‐work rate was achieved in this sample which was initially 92% unemployed. These results indicate that the physician dealing with chronic low back dysfunction can employ objective measures of functional capacity as an alternative to the sole reliance on pain patient self‐report or structured tests, such as radiographie imaging, which merely document a universal, progressive degenerative process.

The relationship of Minnesota Multiphasic Personality Inventory (MMPI) profile clusters to pain behaviors.

Previous research involving cluster analysis of Minnesota Multiphasic Personality Inventory (MMPI) profiles among persons with chronic low back pain has suggested the existence of four distinct profile clusters. The present study had two goals: (1) to replicate the previous finding independently and (2) to investigate the relationship of the profiles to the subjects self-reported pain history and response to treatment. Subjects were 92 patients in a multimodal inpatient low back-pain treatment program. A cluster analysis of the MMPI profiles was performed and the resultant clusters were compared in terms of histories and treatment outcome. The four clusters were successfully replicated for the total sample and for males and females separately. The profiles were significantly related to subjects pain histories, but only one outcome difference was found. It was inferred that the MMPI is of value in understanding patients pain coping behaviors but that further research is needed to explore the utility of the MMPI in understanding their response to treatment.

The failed back - an orthopaedic view

The causes of the failed back syndrome are several. The failure to appropriately identify the structural sources of pain is one. The identities may include radiographically controlled injection procedures. The failure to use sufficiently discrete surgery with an attempt to avoid scar is another cause and the failure to provide an opportunity to avoid and later treat deconditioning is another. The appropriate treatment programme is based on objective assessment of function. Functional achievement as the principal care rather than pain self-report is the most effective manoeuvre to avoid the chronic pain of the failed back syndrome.