Insight and chronic low back pain

The author attempts to clarify the role of psychological factors involved in chronic low back pain. He introduces a so-called « insight concept » as an integral part of the syndrome. The results of a recent study on the subject have brought credit to this theoretical and clinical approach. Twenty-seven patients suffering from chronic low back pain were enrolled in a clinical study which took place in an institution specialized in treatment of such pain syndrome. The principal objective of the study was focused on the predictive consistency of several variables ranging from the personality traits of the patients to the personal and subjective experience of their symptoms. To serve this objective, different assessment criteria were used: NEO PI-R, semi-directive interviews and subjective pain rating scales. (the Dallas Pain Questionnaire, the West Haven-Yale Multidimensional Pain Inventory and the Quebec Back Pain Disability). Furthermore, patients were questioned one year after their treatment in order to estimate the back school’s benefit and impact on their health improvement. This clinical research was done by using the method of the single system design. In a first phase of the results analysis, most of the assumptions involving certain possible psychological factors proved to be groundless in view of the patient’s answers. In a second phase, however, some results presented in this article seem to lead to an alternative conclusion. Not only does insight seem to have played a role as a significant bias in the results, but it may also have modified their progress. Main results stress the divergence of opinions between patients and two other independent evaluators (a doctor and a physical therapist) concerning the improvement of low back pain consecutively to treatment in the back school. Other results show that causal attribution done by patients in regard to their back pain is likely to determine both health improvement and satisfaction with treatment. Finally, according to the results obtained in the NEO PI-R, it seems that the more patients are conscious about their adaptation difficulties and their impulsiveness, the more the back school’s program appears to be beneficial, providing better pain tolerance. As a conclusion, the author poses the question about further investigation of the insight capacities of low-back-pain patients, the way they understand their health problem and their adhesion to the therapy model proposed, in view of optimizing patient’s evaluation and treatment. [Copyright &y& Elsevier]