Depressive disorder, pain perception and pain experience in patients with lumbar intervertebral disk displacement
Hasenbring, M.; Ahrens, S.
Psychotherapie Psychosomatik Medizinische Psychologie 37(5): 149-155
1987
ISSN/ISBN: 0937-2032 PMID: 3602342 Document Number: 295629
Psychosocial variables are being increasingly discussed as an explanation for pain associated with the lumbar radicular syndrome if the pain has become chronic and is not or hardly affected by surgery. In a pilot study with a prospective study design we examined in a random sample taken by the Department of Neurology of the University of Kiel, the Variable Depressivity (using Becks Depression inventory = BDI and the Freiburg Personality Inventory = FPI) as well as sensory and affective aspects of pain sensation (after Hoppe). We examined 38 inpatients in whom prolapse of a lumbar intervertebral disk had been confirmed by myelography, before initiation of treatment, employing the BDI (see above), FPI and Hoppe's pain sensation scale. After completion of treatment we looked for patients who continued to complain of pain with or without sensivity disturbance without any apparent organic cause; in these cases, our search was based on the clinical neurological findings, and we grouped the patients concerned under the designation "unclarified pain syndrome after therapy" (UPaTh, or, in the German text, USn Th). This group (n = 10) differed even before treatment from the other patients (of the control group = CG or in the German text = KG) by a markedly enhanced depression according to the BDI assessment. Using the BDI correct predictions were possible in 86.84% of the cases. On the other hand, the results according to FPI Scale 3 and pain sensitivity scale after Hopper were not in line with our expectations. The discrepancy of the results obtained with BDI on the one hand and FPI Scale 3 on the other are discussed on the basis of two hypotheses: In the first hypothesis, the increased depression recorded in the BDI especially on the somatic and cognitive levels is interpreted as a reaction to pain that had been felt for years, whereas in the second hypothesis these results are interpreted as expressing a "masked depression". According to our results BDI is a helpful screening instrument. It enables us to point to patients requiring differentiated psychodiagnosis in individual cases so that psychological treatment approaches can be offered to accompany the necessary medical therapy.