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Chiropractic Research Review

Addressing Psychosocial Factors of Chronic Pain

Psychosocial factors are possibly the best predictors of the development of chronic low back pain (LBP). This case study illustrates treatment of a patient with chronic pain and disability by addressing psychological factors, using a cognitive-behavioral approach in addition to chiropractic treatment.

The author of this study used a three-step approach to address the patient's psychosocial factors: screening for disability and fear-avoidance; educating the patient about the disease; and incremental (graded) exposure to regular activities and employment.

A 34-year-old police officer with LBP for one year following an accident presented with a "constant ache" (pain rated 5 out of 10 on a visual analog scale) and Oswestry score of 58% (40-60% indicates "severe perceived disability").

He scored significantly lower on a static back endurance test than the normative range for his age. The patient was taking Tylenol 3 and had not yet returned to work; surgeons had concluded that he did not suffer from a surgical lesion.

Chiropractic treatment consisted of adjustments, manual resistive techniques, lumbopelvic stabilizing exercises, and "rocker board" sensorimotor stimulation exercises. Additionally, the man was educated about biomechanics and was given extensive positive reinforcement insisting that pain during generalized movements would not lead to nerve/disc damage. After 12 weeks of three sessions per week, the Oswestry score improved to 30%; VAS rating dropped to 3 out of 10; and the back endurance test was increased from 35 to 55 seconds. The man returned to modified desk duties following treatment.

"This case demonstrates the importance of assessing and treating not only the physical component but also the psychosocial component of the patient presenting with chronic LBP and disability," the author writes. He suggests that this patient developed fear-avoidance beliefs due to uncertainty in the diagnosis/outcome, and the labeling of his condition as herniated/degenerated discs.

Parish KA. A biopsychosocial approach to chronic low back pain and disability in a private chiropractic setting: A case study. Journal of the Canadian Chiropractic Association 2002:46(2), pp. 93-100. www.jcca-online.org

Chiropractic Research Review

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