What is the prognosis of chronic low back pain (cLBP)?

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

Answer

Personality disorders or related traits often affect the prognosis. People with borderline personalities may acquire pain as a method for structuring an otherwise empty existence, whereas patients who are narcissistic may acquire pain and seek medical attention as a way of preventing more serious illness. Those with an antisocial personality are often exploitative and prone to complications, and they may easily adopt game-playing roles. Patients with somatizing and hypochondriacal conditions are most likely to develop pain as a symptom and least likely to respond to treatments aimed at a presumed organic cause. Individuals with depression are prone to chronic pain or to have pain as a symptom. Other personality disorders or disorders that may influence chronic pain include the paranoid, passive-aggressive, and avoidant conditions.

Previous learning and role models also affect the patient's prognosis and treatment outcome. An individual's cognitive or attribution style (eg, the patient's tendency to catastrophize, overgeneralize, personalize, or selectively attend to negative aspects of the pain experience) heavily influence prognosis and treatment outcomes. The physical and emotional trauma that occurred during the injury or that was encountered during the ordeal of convalescence may contribute to the psychosocial milieu and create a host of emotional responses, including anxiety and fear.

Psychophysiological responses may be reinforced and include nightmares, palpitations, diaphoresis, headaches, dizziness, irritability, and fatigue. Patients are often overwhelmed and have feelings of abnormal dependence. They perceive a loss of control and look to their physician, attorney, or family for guidance. Some advisors may be oversolicitous or encourage compensation-seeking or litigation, creating further barriers to recovery.

Enduring prolonged pain also may cause emotional disturbances. Depression has already been mentioned as a common partner to chronic pain and is enhanced by the loss of physical function, low self-esteem, loss of employment, and financial insecurity. Heightened anxiety may occur secondary to continued pain and the associated life disruption. Fear of injury and panic symptoms may also enhance anxiety and complicate the person's recovery. Anger or hostility directed at the workplace or perceived ineffective medical care may hinder communication with physicians, employers, family, and friends. As the length since the injury increases, the aggregation of posttraumatic emotions becomes increasingly complex; avoidance learning and deactivation further complicate the situation.

As these barriers accumulate, the probability of a poor prognosis rises. Neuropsychological factors may preexist or come into effect due to the injury. Limited cognitive function, either premorbid or from brain injury, may limit the patient's capacity to make decisions or succeed in a rehabilitation program.


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