RISK-FACTORS OF CHRONICITY IN LUMBAR DISC PATIENTS - A PROSPECTIVE INVESTIGATION OF BIOLOGIC, PSYCHOLOGIC, AND SOCIAL PREDICTORS OF THERAPYOUTCOME

Study Design. The current prospective longitudinal study examined the predictive value of psychological, somatic and social variables for th e prediction of the short- and long-term follow-up in 111 consecutivel y selected patients with acute radicular pain and a lumbar disc prolap se or protrusion. Objectives. The criteria for the therapy outcome wer e the intensity of persistent pain at the time of the discharge from t he hospital and 6 months later and the application for early retiremen t at the 6 month follow-up. Methods. As for the psychological predicto rs, we examined depression (Beck Depression Inventory BDI), daily hass les (Kiel Interview of the Subjective Situation KISS), pain coping str ategies (Kiel Pain Inventory KSI), and Health locus of control (GKU). As somatic predictors, we assessed the duration of pain before treatme nt, previous operations, paresis, disc displacement, scoliosis, adipos itas, treatment, and age. As social predictors, we assessed the social status, occupational characteristics, and the duration of inability t o work. Results. The results indicated that persistent pain was best p redicted by a combination of somatic (degree of disc displacement), ps ychological (depression and the pain coping strategies avoidance behav ior, endurance strategies, nonverbal pain behavior and search for soci al for social support), and social parameters (social status and sitti ng position) with a correct prediction in 86%. The application for ear ly retirement at the 6 month follow-up was best predicted by depressio n and stress at work. Conclusions. The results lead to several hypothe ses about biopsychosocial interrelations within the chronification of radicular pain and provide the clinician with a short screening instru ment for early diagnosis of chronification.