Orthopedics play a major role dealing with various diseases that cause chronic lower back pain, but patient expectations are sometimes not fully satisfied. This is because of the complexity of mechanisms of back pain and they involve social and psychological factors. Hence evaluating back pain is a cumbersome task.
Existence of psychosocial factors is a factor in the occurrence in low pain with disability and this contributes to the chronicity of the pain. In recent years, analysis of brain activity has become possible with functional brain imaging and other techniques, and the mechanisms underlying chronic low back pain are being elucidated.
Existence of psychosocial factors is a factor in the occurrence in low pain with disability and this contributes to the chronicity of the pain. In recent years, analysis of brain activity has become possible with functional brain imaging and other techniques, and the mechanisms underlying chronic low back pain are being elucidated.
Psychological Factors
Basically pain the categorized into 3 categories- nociceptive pain, neuropathic pain and non-organic pain. Also chronic lower back pain show decreased activity of the brain areas like- prefrontal cortex, anterior cingulate cortex and nucleus accumbens.
To determine the degree of pain doctors use a tool called- BS-POP scale (Brief Scale for Psychiatric problems in Orthopedic Patients). This toll is used to asses the psychological aspects of the brain.
Basically pain the categorized into 3 categories- nociceptive pain, neuropathic pain and non-organic pain. Also chronic lower back pain show decreased activity of the brain areas like- prefrontal cortex, anterior cingulate cortex and nucleus accumbens.
To determine the degree of pain doctors use a tool called- BS-POP scale (Brief Scale for Psychiatric problems in Orthopedic Patients). This toll is used to asses the psychological aspects of the brain.
BS-POP SCALE
- Physician version- 8 questions with scores ranging from 8-24 points, with the physician answering the questions based on patient assessment.
- Patient version- 10 questions with scores ranging from 10-30 points, with the patient answering the questions.
Brain Mechanism for chronic Pain by Brain imaging-
Neuro-imaging has enabled us to make great progress in identifying many neural mechanisms that contribute to chronic pain. This provides us with a new perception of the nature of chronic pain, research on a whole-brain approach to study and treatment of chronic pain and develop novel technologies and analysis techniques, etc.
Psychological factors like stress and depression are involved in chronicity of the pain. The meso limbic dopamine system plays a very important role in the pain pathway stimulus. Dopamine release occurs not just with painful stimulus , but with also expectation of rewards.
Neuro-imaging has enabled us to make great progress in identifying many neural mechanisms that contribute to chronic pain. This provides us with a new perception of the nature of chronic pain, research on a whole-brain approach to study and treatment of chronic pain and develop novel technologies and analysis techniques, etc.
Psychological factors like stress and depression are involved in chronicity of the pain. The meso limbic dopamine system plays a very important role in the pain pathway stimulus. Dopamine release occurs not just with painful stimulus , but with also expectation of rewards.
Pain Pleasure system
Pain is inhibited by pleasurable sensation- like pleasant smell or images, favorite music, favorite food, etc have shown clear efficacy in inhibiting pain. Introduction of medical practice of pleasant smell(aromatherapy), pleasant music and similar sensations are soothing to patients with chronic back pain.
A Mindfulness- based stress reduction (MBSR) can help reduce back pain and improve emotional control by increasing blood flow to the frontal lobe. This also helps reduce anxiety.
Cognitive behavior therapy (CBT) is especially helpful along with progressive muscle relaxation.
Pain is inhibited by pleasurable sensation- like pleasant smell or images, favorite music, favorite food, etc have shown clear efficacy in inhibiting pain. Introduction of medical practice of pleasant smell(aromatherapy), pleasant music and similar sensations are soothing to patients with chronic back pain.
A Mindfulness- based stress reduction (MBSR) can help reduce back pain and improve emotional control by increasing blood flow to the frontal lobe. This also helps reduce anxiety.
Cognitive behavior therapy (CBT) is especially helpful along with progressive muscle relaxation.
Conclusion
Chronic lower back pain is associated with psychiatric factors. BS-POP is useful in screening tool for psychiatric factors. Multifaceted evaluation including brain function is needed to clarify the mechanisms of chronic lower back pain.