Psychiatric Morbidity in Chronic Low Back Pain-A Cross-Sectional Study

Abstract

Introduction: Psychiatric disorders are found to be predisposing or perpetuating factors in patients with Chronic Low Back Pain (CLBP) and these may also arise as a consequence of CLBP. More than one third of patients with CLBP are reported to have psychiatric morbidity along with physical or radiological signs and another third has no physical or radiological signs, but only psychiatric disorders. On the basis of clinical and radiological findings and presence of psychiatric diagnosis, patients with CLBP can be grouped in to three: 1) those with psychiatric disorder alone- the psychiatric group; 2) those with only physical illness with no psychiatric disorder- the organic group; and 3) group with both physical illness with psychiatric disorder-the combined group. Prevalence of psychiatric disorders in CLBP is understudied. Identification and treatment of psychiatric disorders in CLBP will help to reduce disability. Aim: To assess the type of psychiatric disorders and to compare psychiatric disorders between psychiatric, non-psychiatric and combined group of CLBP. Materials and Methods: This was a cross-sectional observational study conducted in 92 consecutive patients presented with CLBP (back pain lasting for more than 12 weeks duration) to outpatient orthopaedics department during April to September 2001. These patients were evaluated for physical disorders using clinical and radiological examinations and psychiatric disorders using ICD 10 Classification of Mental and Behavioural DisorderDiagnostic Criteria for Research (DCR). On the basis of clinical and radiological findings and presence of psychiatric diagnosis, subjects were grouped in to three; psychiatric group, organic group and the combined group. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 16.0. Sociodemographic and clinical characteristics between the groups were compared using Chi-square test for categorical variables and ANOVA for continuous variables. Results: Of 92 subjects 45(48.9%) belonged to the combined group, 38(41.3%) to psychiatric group and 9(9.8%) to organic disorder group. Depressive disorder was significantly higher (p=0.01) but somatoform disorder was significantly lower in combined group (p<0.01) compared to psychiatric group. There were more patients with severe pain in psychiatric group compared to other two groups (p<0.05). Conclusion: Psychiatric disorders are highly prevalent in CLBP. Proper and timely identification of psychiatric disorders may help clinicians to judiciously select the treatment in CLBP.

Keywords

• back ache
• depression
• somatoform pain disorder