How are the barriers to recovery in chronic low back pain (cLBP) categorized?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Answer

Barriers to recovery may be premorbid, result from traumatic injury, or develop over time as a result of psychological and environmental influences. These barriers strongly influence chronicity and the patient's prognosis. For example, medical problems, such as diabetes or heart disease, may make the patient a poor candidate for rehabilitation or surgery. Failed back surgery may create permanent physical and psychological obstacles.

Patients differ in their inherent capacity to exercise. Deconditioning syndrome, a term Mayer coined, is caused by prolonged reduction of physical activity due to cLBP. This syndrome is associated with a gradual reduction in muscle strength, joint mobility, and cardiovascular fitness, which over time may become a self-sustaining and independent component of the individual's musculoskeletal illness.

Preexisting psychological factors may combine with lower back injuries to create a pain syndrome with predominantly psychiatric features. Psychiatric interviews of 200 patients with cLBP entering a functional restoration (FR) program revealed that 77% met lifetime diagnostic criteria for psychiatric syndromes, even when the category of somatoform pain disorder was excluded. In addition, 51% met the criteria for at least 1 personality disorder.


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