Back pain in the pain clinic: nature and management

This paper describes 2007 patients with back pain seen in 10 out-patient pain clinics in northern Britain. For 761 patients with low back pain the adequacy of management prior to referral to the pain clinic is assessed by comparing prior care with care in the pain clinic. Over one-third of patients (37 per cent) seen in the pain clinics had low back pain. They were mostly long-term sufferers (73 per cent had been in pain for over 2 years) and almost three-quarters (72 per cent) reported their pain as moderate or severe. The putative cause of the back pain was predominantly 'degenerative' (56 per cent) or 'trauma' (21 per cent). However, 16 per cent had had previous surgery, which was felt to contribute to their pain problem. One in seven (15 per cent) had no definite cause of their pain and almost half (46 per cent) were identified as having a psychological component to their pain. Following referral to the pain clinic many patients received previously untried treatments. For example, only about one in 10 patients had tried antidepressants prior to referral but over 40 per cent tried them during pain clinic care; and over 70 per cent of patients tried transcutaneous electrical nerve stimulation in the pain clinic compared with just 12 per cent previously. However, despite the recognized need, only 17 per cent received any sort of psychological therapy. Chronic low back pain forms a major part of the work of pain clinics. The patients seen have severe and often complex problems. Being referred to the pain clinic may extend the range of therapeutic options for these patients. However, many patients require greater attention to be paid to the psychosocial dimensions of their pain problems.