Childhood psychological trauma and chronic refractory low-back pain.

OBJECTIVE

To examine the correlation between childhood psychological trauma(s) and refractory back pain in patients with and patients without prior spine surgery.

DESIGN

Retrospective chart review survey of 101 consecutive patients who had undergone multidisciplinary evaluation for refractory back pain.

SETTING

Private practice, tertiary care spine center.

MAIN OUTCOME MEASURES

Each psychological risk factor (physical abuse, sexual abuse, emotional neglect or abuse, abandonment, and chemically dependent caregiver) was rated as present or absent. Spinal pathology was graded as significant or not significant.

RESULTS

There were 56 patients with failed back surgery syndrome, 28 men and 28 women, with a mean age of 43 and mean pain duration of 45 months. There were 45 patients with no prior surgery, 26 men and 19 women, with a mean age of 43 and mean pain duration of 33 months. In the failed back surgery syndrome group, 27 (48%) had three or more risks and 39 (70%) had two or more. When the 12 patients with significant pathology are not considered, 24 of the remaining 44 (55%) patients had three or more risks. In the group with no prior surgery, 26 (58%) had three or more risks and 38 (84%) had two or more. When the five patients with significant pathology are not considered, 24 (60%) had three or more risks.

CONCLUSIONS

Multiple childhood psychological traumas may predispose a person to chronic low back pain. In patients in this setting with refractory low back pain with or without prior lumbar spine surgery, three or more childhood psychological risk factors are prevalent, especially in patients with minimal structural pathology.