On the utility of the SCL-90-R with low-back pain patients

The SCL-90-R has become an increasingly popular measure of maladjustment. Its use beyond simply screening chronic low-back pain (CLBP) patients has been criticized, however, in part, because it appears to be a single-factor instrument. In fact, its nine major scales do share only one important common factor, i.e., general psychological discomfort. The scale most applicable to CLBP, however, somatization (SOM), has sufficient specific variance that it does not simply measure discomfort and predicts several other measures better than the SCL-90-Rs more reliable composite measure (GSI). Using SOM in conjunction with the GSI to separate psychological from physical discomfort is therefore both clinically and psychometrically appropriate. Other objections to the test are critically evaluated. The potential clinical relevance of the SCL-90-R is discussed.