How are psychosocial issues affecting mechanical back pain assessed?

Updated: Aug 27, 2020
  • Author: Debra G Perina, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Answer

Certain clinical clues can help differentiate causes. Generally, impingement syndromes produce positive straight-leg-raising tests, whereas pure irritation does not. Mechanical low back pain is a common complaint in patients with functional disorders. In addition, a functional overlay or component of secondary gain may be present in some patients with true organic pathology. [20]  The degree of psychosocial issues [43] affecting the patient's condition may be assessed by the following:

  • Patient may receive compensation for injury.

  • Patient has pending litigation.

  • Patient dislikes job.

  • Patient has symptoms of depression.

  • Patient caused the accident resulting in back pain.

  • Physical clues that help identify patients with significant functional overlay or component of secondary gain include the following: findings of nonanatomic motor or sensory loss, nonspecific tenderness or generalized tenderness over the entire back, and overly dramatic behavior and loss of positive straight-leg-raising test when patient is distracted

  • A particularly useful test is to have patients hold their wrists next to their hips and turn their body from side to side. This test gives the illusion that you are testing spinal rotation, but no actual stress is placed on any muscles or ligaments. Any complaint of pain during this maneuver is strongly suggestive of a functional overlay or component of secondary gain in the presentation.


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