[Treatment of low back pain (pain of locomotive organs)]

Hirotaka Tanikawa
Nihon Rinsho. Japanese Journal of Clinical Medicine 2009, 67 (9): 1783-90
Several diseases, including the functional somatic syndromes (FSS), are characterized by pain involving locomotive structures. These disorders include low back pain, neck-shoulder-arm syndrome and fibromyalgia. FSS patients are convinced that their illness is not a psychosomatic disorder, being instead a bodily disease. Therefore, physicians such as orthopedic surgeons play an important role in supporting patients suffering from FSS with locomotive pain, because these patients expect their physicians to treat them for a physical, rather than a psychological disorder. The author investigated the patient-doctor relationship in the examination room of a hospital, and designated pain combined with a depressive state characterized by agitation and helplessness, a common complaint made by FSS and psychosomatic disorder patients, 'painful depression'. Pain and depression influence each other and trigger a vicious downward spiral termed the 'pain-depression deflation spiral'. Generally, orthopedic surgeons can achieve good relationships with FSS patients with locomotive structure pain, despite suspicion of psycho-social factors. It is concluded that physical examinations and treatments by orthopedic surgeons, conducting physical examinations only, can serve as a very good psychosomatic approach to painful depression/FSS patients.

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