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Research:
Showing The Benefits Of Psychological Testing And Treatment To Predict and Expedite Injury Recovery
The medical process to arrive at a diagnosis requires a patient history, physical exam, and diagnostic tests. Generally, 85% of the diagnosis relies upon the history. The physical exam contributes 10 % to the diagnosis. Tests for a patient with low back and lower extremity pain include lumbar spine x-rays (films), CT scans (computed axial tomography scans), MRI scans (magnetic resonance imaging), myelograms, post myelographic CT scans, EMG/NCV (electromyogram/nerve conduction velocity) studies, discograms, and bone density tests. Studies show that psychosocial factors are so potent, researchers can predict whether pain will become chronic; whether people will seek treatment for their pain; and what kind of treatment people respond to best.
The longer pain lasts without relief, the more difficult and expensive it becomes to treat. In the case of lower back pain, only five to ten percent of people with acute pain develop chronic pain--defined as lasting more than six months. However, chronic pain disability accounts for 80 percent of the money spent for back care in the United States.
In a study of 504 people with acute lower back pain--supported by grants from the National Institutes of Health--Gatchel and his colleagues identified four psychosocial factors that predicted whose pain became chronic. The people who were still disabled by their pain a year after it began:
- Reported more intense pain and more disability from their pain;
- Scored high on scale 3 of the Minnesota Multiphasic Personality Inventory, which measures a person's sensitivity to bodily sensations, as well as a tendency to deny any emotional or interpersonal difficulties;
- Received some type of worker's compensation or were involved in a personal-injury case; and
- Were more likely to be women.
There are a number of psychosocial and economic variables that predict who might be more prone to develop chronic pain and disability. An psychological assessment battery can tap into these factors in order to flag people early and intervene to prevent acute pain from becoming chronic. If clinicians can get these people back into their normal routine as quickly as possible, it may help prevent motivational issues from developing (malingering, somatization).
A psychosocial assessment is critical to getting people the treatment they need, said Dennis Turk, PhD, of the University of Washington. Anyone with chronic pain--from lower-back troubles to rheumatoid arthritis--should be assessed medically and psychosocially before being treated . He and his colleagues have defined three subtypes of people who are evaluated at pain centers:
- Dysfunctional patients report high levels of pain and psychological distress, feel they have little control over their lives and are extremely inactive.
- Interpersonally distressed patients feel they have little social support and report that significant others don't take their pain seriously.
- Adaptive copers report far less pain and social distress than people in the other two groups and continue to function at a relatively high level.
The key is tailoring those treatments to match a person's psychosocial diagnosis, he said. Many studies have found that behavioral treatments can help people with chronic pain, but Turk obtains better, longer-lasting results when he matches treatments to patients. People who received stress-management treatment and a bite plate to treat physical symptoms reported less pain and psychological distress after treatment. However, after six months, dysfunctional patients often relapsed. When the researcher
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