[The importance of bodily complaints in patients with chronic back pain]

Pain perception is a complex psychosomatic phenomenon and is influenced by different psychological variables. Apart from their pain perception, chronic pain patients also suffer from different bodily complaints. The clinical significance of this finding is not yet clear. Bodily complaints in chronic pain patients may represent (a) a bodily expression of depressive symptoms, (b) a sign of chronicity, and (c) the expression of a heightened bodily awareness in the sense of hypochondriasis.

A psychometric study was done with 83 patients with chronic low-back pain. The patients were interviewed and tested psychometrically. We administered a German scale to measure bodily complaints (BL), an inventory to measure the extent of depressive symptoms (DS) and two subscales of an personality inventory (bodily complaints and hypochondriasis). In addition, patients were evaluated according to three stages of chronification ("Mainz Pain Staging System"). Ten anamnestic variables from four dimensions (temporal aspects, spatial aspects, medication usage behavior and patient's health care history) are added to yield a total chronification stage with three stages ranging from acute to chronic pain.

Results indicate that bodily complaints have to be interpreted as signs of depressive disorder and chronicity. Signs of bodily 'awareness' or 'somatic anxiety'- in the sense of hypochondriasis - could not be found. Hypochondriasis does not seem to play a significant role in chronification of low back pain.

From a cognitive-behavioral perspective the results support the hypothesis that psychological disturbance in chronic pain is a cause of long-standing pain perception and the result of the chronification process.