Neurológia pre prax 2/2009

Back pain as a psychological problem

This contribution addresses the challenge of chronic non-specific lower back pain (LBP), a matter often accompanied by a degree of unpleasantness for family doctors, vertebrologists, and many other carers. LBP sufferers search various segments of the health care system with considerable energy, sometimes approaching the point of abuse. Most physicians approach this problem through the so-called „biological” model of pain, i. e. by means of imaging and other diagnostic work-up they try to identify the pathological issue leading to the pain and remove it by pharmaceutical and/or surgical means. This classic model has not proved appropriate in chronic non-specific LBP and mirrors one of the causes of unsatisfactory results in more widespread treatment. An increasing number of studies published in recent years recommend the employment of what is known as the operant conditioning model, and present evidence of high efficacy for such a congitive-behavioral approach to LBP. The author addresses the principle of this model in the control of LBP in some detail.

Keywords: „biological” model of pain, operant conditining model, congitive-behavioral approach, non-specific back pain