Psychological Stress Better Predictor of Back Pain Than Standard Diagnostic Techniques

Join Our Community of Science Lovers!

On supporting science journalism

If you're enjoying this article, consider supporting our award-winning journalism by subscribing. By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today.

Doctors often have a difficult time diagnosing a physical cause for some patients¿ lower back pain, which can be debilitating. A new report suggests that psychological distress may be a better indicator than medical imaging or injections when it comes to predicting who will develop aching backs.

Eugene J. Carragee of Stanford University and his colleagues tracked nearly 100 people over a four-year period to try to determine how effective predictive measures for lower back pain are. At the start of the study, the researchers used magnetic resonance imaging (MRI), which can identify small cracks or tears in cartilage, to examine the spines of 46 volunteers who did not suffer from lower back pain. In addition, the subjects underwent a procedure known as discography, in which a doctor injects fluid into the spine. If the injections cause pain, the theory holds, the patient may later develop back pain even if he doesn¿t currently suffer from it. Over the course of the study, the volunteers, along with a control group, completed yearly physical and psychological evaluations.

The researchers determined that patients suffering psychological distress were three times more likely to develop back pain than those with better coping skills. "The structural problems were really overwhelmed by the psychosocial factors," Carragee says. Experiencing other types of chronic pain was also linked to developing back pain, but discography results did not successfully predict future back problems, and the association between MRI results and back pain was not statistically significant. The team is now working on a five-year study that examines a more high-risk group of patients who already have common back pain. Notes Carragee: "The question is, Can we better identify groups that have a greater chance of being helped by surgery?" The study results appear in the May 15 issue of the journal Spine.

Subscribe to Support Independent Journalism

Great science journalism requires human expertise, time, effort and creativity. And it costs money. That’s why I and the journalists here at Scientific American hope you’ll join our community.

When you subscribe, you are supporting staff and freelance journalists who are passionate about telling science stories that are true, important and compelling. Our editors and reporters are often experts in their fields, which means they understand the nuances of big discoveries and can untangle the breakthroughs from the hype. With a subscription, you are also supporting rigorous fact-checking to ensure the words we publish are precise and accurate. And you’re supporting original illustrations, graphics and photos that bring you closer to an advanced laboratory, an ice sheet in Antarctica or a space mission in orbit. You’re helping us craft other types of high-quality journalism as well: Our newsletters are carefully written, edited and curated by staffers you have or will come to know and love. Our Science Quickly podcast is based on original reporting, collaboration with editors and scientists and exacting production.

Subscriptions keep this engine running so we can continue to deliver thoughtful, rigorous and independent science journalism to you. In an era of viral misinformation, this work is crucial. If you value what we do, I hope you’ll consider joining us as a subscriber

Thank you,

Jeanna Bryner, Editor in Chief, Scientific American