A Bad Situation Made Worse
It has been said that even the longest journey begins with a single step. In some cases, such a journey can also begin with a single misstep.
Sarah was 39-year-old woman who had worked as an administrative assistant at a company for 8 years. One day at work, while walking between buildings, Sarah had the misfortune to slip on some ice. She twisted her left ankle and fell, landing on her left side and wrenching her lower back. This accident was not witnessed however, and when she reported her injury, her employer was skeptical that she had really injured herself at work. Her employer initially resisted filing a worker compensation claim, and suggested that she was actually injured at home. She was directed to see her personal physician. When she presented for examination by her personal physician though, she was told that this was a work-related injury, and her physician referred her to her company’s occupational medicine physician. Some days later, Sarah was told that her worker’s compensation claim had been approved provisionally, although she was also told that the claim was being investigated by her insurer.
Physical examination by the occupational medicine physician revealed some tenderness around the left ankle, but the radiographs found a normal left ankle. Physical examination also revealed a considerable tenderness in the musculature of the lumbar back, primarily on the left, with the patient reacting to even a light touch. Although the neurological examination was normal, radiographs revealed some minimal lumbar degenerative disk disease and a normal left ankle. Sarah denied any past history of injuries to her back or lower extremities. She reported occasional low-back pain in the past, but no lost-time injuries and no surgeries. Sarah reported being otherwise healthy, with no chronic medical conditions, and she was not taking any medication on a regular basis. She reported a family history of diabetes and heart disease on her father’s side, and she was a nonsmoker.
KeywordsChronic Pain Lumbar Fusion Lumbar Discectomy Lumbar Disc Surgery Lumbar Intervertebral Disc Herniation
Merskey H, Bogduk N. Classification of Chronic Pain
. 2nd ed. Seattle: IASP Press; 1994.Google Scholar
National Center for Health Statistics (1992). Reporting chronic pain episodes on health surveys. (DHHS Publication No. (PHS) 92–1081). Washington, DC: Government Printing Office.Google Scholar
Loeser JD. Economic implications of pain management. Acta Anaesthesiol Scand
. 1999;43(9):957–959.PubMedCrossRefGoogle Scholar
Bruns D, Disorbio JM. Chronic pain and biopsychosocial disorders: the BHI 2 approach to classification and assessment. Pract Pain Manag
. 2005;5(7):52–61.Google Scholar
Gallagher RM. Biopsychosocial pain medicine and mind-brain-body science. Phys Med Rehabil Clin N Am.
204;15(4):855–882, vii.Google Scholar
Gatchel RJ, Polatin PB, Mayer TG, Garcy PD. Psychopathology and the rehabilitation of patients with chronic low back pain disability. Arch Phys Med Rehabil
. 1994;75(6):666–670.PubMedCrossRefGoogle Scholar
Gray PB. Deluxe doctors. Fortune Small Bus.
July 18, 2004.Google Scholar
Higgins ES. A review of unrecognized mental illness in primary care. Prevalence, natural history, and efforts to change the course. Arch Fam Med.
Disorbio JM, Bruns D, Barolat G. Assessment and treatment of chronic pain: a physician’s guide to a biopsychosocial approach. Pract Pain Manag
. 2006;6(2):11–27.Google Scholar
Meyer GJ, Finn SE, Eyde LD, Kay GG, Moreland KL, Dies RR, et al. Psychological testing and psychological assessment. a review of evidence and issues. Am Psychol.
Carragee EJ, Alamin TF, Miller JL, Carragee JM. Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain. Spine J
. 2005;5(1):24–35.PubMedCrossRefGoogle Scholar
Gatchel RJ, Polatin PB, Mayer TG. The dominant role of psychosocial risk factors in the development of chronic low back pain disability. Spine
. 1995;20(24):2702–2709.PubMedCrossRefGoogle Scholar
Block AR, Gatchel RJ, Deardorff WW, Guyer RD. The Psychology of Spine Surgery.
Washington, DC: American Psychological Association; 2003.CrossRefGoogle Scholar
Block AR, Ohnmeiss DD, Guyer RD, Rashbaum RF, Hochschuler SH. The use of presurgical psychological screening to predict the outcome of spine surgery. Spine J.
Epker J, Block AR. Presurgical psychological screening in back pain patients: a review. Clin J Pain
. 2001;17(3):200–205.PubMedCrossRefGoogle Scholar
Gatchel RJ. A biopsychosocial overview of pretreatment screening of patients with pain. Clin J Pain.
Schofferman J, Anderson D, Hines R, Smith G, White A. Childhood psychological trauma correlates with unsuccessful lumbar spine surgery. Spine
. 1992;17(6 Suppl):S138–144.PubMedGoogle Scholar
Bruns D, Disorbio JM. Battery for Health Improvement 2 Manual.
Minneapolis: Pearson; 2003.Google Scholar
Anderson M.W. Lumbar discography: an update. Semin Roentgenol
. 2004;39(1):52–67.PubMedCrossRefGoogle Scholar
Arpino L, Iavarone A, Parlato C, Moraci A. Prognostic role of depression after lumbar disc surgery. Neurol Sci
. 2004;25(3):145–147.PubMedCrossRefGoogle Scholar
DeBerard MS, Masters KS, Colledge AL, Schleusener RL, Schlegel JD. Outcomes of posterolateral lumbar fusion in Utah patients receiving workers’ compensation: a retrospective cohort study. Spine.
2001;26(7):738–746; discussion 747.PubMedCrossRefGoogle Scholar
Donceel P, Du Bois M. Predictors for work incapacity continuing after disc surgery. Scand J Work Environ Health
. 1999;25(3):264–271.PubMedGoogle Scholar
Hagg O, Fritzell P, Ekselius L, Nordwall A. Predictors of outcome in fusion surgery for chronic low back pain. A report from the Swedish lumbar spine study. Eur Spine J.
Junge A, Dvorak J, Ahrens S. Predictors of bad and good outcomes of lumbar disc surgery. A prospective clinical study with recommendations for screening to avoid bad outcomes. Spine.
Kjellby-Wendt G, Styf JR, Carlsson SG. The predictive value of psychometric analysis in patients treated by extirpation of lumbar intervertebral disc herniation. J Spinal Disord
. 1999;12(5):375–379.PubMedCrossRefGoogle Scholar
LaCaille RA, DeBerard MS, Masters KS, Colledge AL, Bacon W. Presurgical biopsychosocial factors predict multidimensional patient: outcomes of interbody cage lumbar fusion. Spine J
. 2005;5(1):71–78.PubMedCrossRefGoogle Scholar
Penta M, Fraser RD. Anterior lumbar interbody fusion. A minimum 10-year follow-up. Spine.
Riley JL 3rd, Robinson ME, Geisser ME, Wittmer VT, Smith AG. Relationship between MMPI-2 cluster profiles and surgical outcome in low-back pain patients. J Spinal Disord
Schade V, Semmer N, Main CJ, Hora J, Boos N. The impact of clinical, morphological, psychosocial and work-related factors on the outcome of lumbar discectomy. Pain
. 1999;80(1–2):239–249.PubMedCrossRefGoogle Scholar
Trief PM, Grant W, Fredrickson B. A prospective study of psychological predictors of lumbar surgery outcome. Spine
. 2000;25(20):2616–2621.PubMedCrossRefGoogle Scholar
Carter LE, McNeil DW, Vowles KE, Sorrell JT, Turk CL, Ries BJ, et al. Effects of emotion on pain reports, tolerance and physiology. Pain Res Manag
. 2002;7(1):21–30.PubMedGoogle Scholar
Rome HP Jr, Rome JD. Limbically augmented pain syndrome (LAPS): kindling, corticolimbic sensitization, and the convergence of affective and sensory symptoms in chronic pain disorders. Pain Med
. 2000;1(1):7–23.PubMedCrossRefGoogle Scholar
Zelman DC, Howland EW, Nichols SN, Cleeland CS. The effects of induced mood on laboratory pain. Pain
. 1991;46(1):105–111.PubMedCrossRefGoogle Scholar
Gehi A, Haas D, Pipkin S, Whooley MA. Depression and medication adherence in outpatients with coronary heart disease: findings from the heart and soul study. Arch Intern Med
. 2005;165(21):2508–2513.PubMedCrossRefGoogle Scholar
Broadhead WE, Blazer DG, George LK, Tse CK. Depression, disability days, and days lost from work in a prospective epidemiologic survey. JAMA
. 1990;264(19):2524–2528.PubMedCrossRefGoogle Scholar
Roberts SJ. The sequelae of childhood sexual abuse: A primary care focus for adult female survivors. Nurse Pract.
1996;21(12 Pt 1):42, 45, 49–52.PubMedCrossRefGoogle Scholar
Kiecolt-Glaser JK, Glaser R. Psychoneuroimmunology and cancer: fact or fiction? Eur J Cancer
. 1999;35(11):1603–1607.PubMedCrossRefGoogle Scholar
Miller GE, Dopp JM, Myers HF, Stevens SY, Fahey JL. Psychosocial predictors of natural killer cell mobilization during marital conflict. Health Psychol
. 1999;18(3):262–271.PubMedCrossRefGoogle Scholar
Takahashi K, Iwase M, Yamashita K, Tatsumoto Y, Ue H, Kuratsune H, et al. The elevation of natural killer cell activity induced by laughter in a crossover designed study. Int J Mol Med
. 2001;8(6):645–650.PubMedGoogle Scholar
Kiecolt-Glaser J.K, McGuire L, Robles TF, Glaser R. Psychoneuroimmunology and psychosomatic medicine: back to the future. Psychosom Med
. 2002;64(1):15–28.PubMedGoogle Scholar
Marucha PT, Kiecolt-Glaser JK, Favagehi M. Mucosal wound healing is impaired by examination stress. Psychosom Med
. 1998;60(3):362–365.PubMedGoogle Scholar
Doxey NC, Dzioba RB, Mitson GL, Lacroix JM. Predictors of outcome in back surgery candidates. J Clin Psychol
. 1988;44(4):611–622.PubMedCrossRefGoogle Scholar
Dzioba RB, Doxey NC. A prospective investigation into the orthopaedic and psychologic predictors of outcome of first lumbar surgery following industrial injury. Spine
. 1984;9 (6):614–623.PubMedCrossRefGoogle Scholar
Graver V, Ljunggren AE, Malt UF, Loeb M, Haaland AK, Magnaes B, et al. Can psychological traits predict the outcome of lumbar disc surgery when anamnestic and physiological risk factors are controlled for? Results of a prospective cohort study. J Psychosom Res
. 1995;39(4):465–476.PubMedCrossRefGoogle Scholar
Herron L, Turner J, Weiner P. Does the MMPI predict chemonucleolysis outcome? Spine
. 1988;13(1):84–88.PubMedCrossRefGoogle Scholar
Sorensen LV. Preoperative psychological testing with the MMPI at first operation for prolapsed lumbar disc. Five-year follow up. Dan Med Bull.
Turner JA, Ersek M, Herron L, Haselkorn J, Kent D, Ciol MA, et al. Patient outcomes after lumbar spinal fusions. JAMA
. 1992;268(7):907–911.PubMedCrossRefGoogle Scholar
Turner JA, Herron L, Weiner P. Utility of the MMPI pain assessment index in predicting outcome after lumbar surgery. J Clin Psychol
. 1986;42(5):764–769.PubMedCrossRefGoogle Scholar
Bernard TN Jr. Repeat lumbar spine surgery. factors influencing outcome. Spine.
Taylor VM, Deyo RA, Ciol M, Farrar EL, Lawrence MS, Shonnard NH, et al. Patient-oriented outcomes from low back surgery: a community-based study. Spine
. 2000;25(19):2445–2452.PubMedCrossRefGoogle Scholar
Deyo RA, Mirza SK, Heagerty PJ, Turner JA, Martin BI. A prospective cohort study of surgical treatment for back pain with degenerated discs; study protocol. BMC Musculoskelet Disord
. 2005;6(1):24.PubMedCrossRefGoogle Scholar
Glassman SD, Minkow RE, Dimar JR, Puno RM, Raque GH, Johnson JR. Effect of prior lumbar discectomy on outcome of lumbar fusion: a prospective analysis using the SF-36 measure. J Spinal Disord
. 1998;11(5):383–388.PubMedCrossRefGoogle Scholar
Greenough CG, Taylor LJ, Fraser RD. Anterior lumbar fusion. A comparison of noncompensation patients with compensation patients. Clin Orthop Relat Res
Groth-Marnat G, Fletcher A. Influence of neuroticism, catastrophizing, pain duration, and receipt of compensation on short-term response to nerve block treatment for chronic back pain. J Behav Med
. 2000;23(4):339–350.PubMedCrossRefGoogle Scholar
Klekamp J, McCarty E, Spengler DM. Results of elective lumbar discectomy for patients involved in the workers’ compensation system. J Spinal Disord
. 1998;11(4):277–282.PubMedCrossRefGoogle Scholar
Mannion AF, Elfering A. Predictors of surgical outcome and their assessment. Eur Spine J
. 2006;15(Suppl 1) S93–108.PubMedCrossRefGoogle Scholar
Rohling ML, Binder LM, Langhinrichsen-Rohling J. Money matters: a meta-analytic review of the association between financial compensation and the experience and treatment of chronic pain. Health Psychol
. 1995;14(6):537–547.PubMedCrossRefGoogle Scholar
Turk DC, Flor H. Chronic pain: a biobehavioral perspective. In; Gatchel RJ, Turk DC, eds. Psychosocial Factors in Pain: Critical Perspectives.
New York: Guilford; 1999.Google Scholar
Gatchel RJ. Comorbidity of chronic pain and mental health disorders: the biopsychosocial perspective. Am Psychol
. 2004;59(8):795–805.PubMedCrossRefGoogle Scholar
Grace VM. Pitfalls of the medical paradigm in chronic pelvic pain. Baillieres Best Pract Res Clin Obstet Gynaecol
. 2000;14(3):525–539.PubMedCrossRefGoogle Scholar
Hyams JS. Irritable bowel syndrome, functional dyspepsia, and functional abdominal pain syndrome. Adolesc Med Clin
. 2004;15(1):1–15.PubMedCrossRefGoogle Scholar
Ong KS, Keng SB. The biological, social, and psychological relationship between depression and chronic pain. Cranio
. 2003;21(4):286–294.PubMedGoogle Scholar
Turk DC, Okifuji A. Psychological factors in chronic pain: evolution and revolution. J Consult Clin Psychol
. 2002;70(3):678–690.PubMedCrossRefGoogle Scholar
Hamberg K, Johansson E, Lindgren G, Westman G. The impact of marital relationship on the rehabilitation process in a group of women with long-term musculoskeletal disorders. Scand J Soc Med
. 1997;25(1):17–25.PubMedGoogle Scholar
MacGregor EA, Brandes J, Eikermann A, Giammarco R. Impact of migraine on patients and their families: the migraine and zolmitriptan evaluation (maze) survey—phase III. Curr Med Res Opin
. 2004;20(7):1143–1150.PubMedCrossRefGoogle Scholar
Harris S, Morley S, Barton SB. Role loss and emotional adjustment in chronic pain. Pain
. 2003;105(1–2):363–370.PubMedCrossRefGoogle Scholar
Kemler MA, Furnee CA. The impact of chronic pain on life in the household. J Pain Symptom Manage.
Maruta T. Depression associated with chronic pain: Incidence, characteristics, and long-term outcome. Keio J Med
. 1989;38(4):403–412.PubMedGoogle Scholar
American College of Occupational and Environmental Medicine. Occupational Medicine Practice Guidelines: Evaluation and Management of Common Health Problems and Functional Recovery of Workers.
2nd ed. Beverly Farms, MA: OEM Press; 2004.Google Scholar
Mayer TG, Polatin PB, Smith B, Smith C, Gatchel RJ, Herring SA, et al. Spine Rehabilitation: Secondary and Tertiary Nonoperative Care.
LaGrange, IL: North American Spine Society; 1994.Google Scholar
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