Health-related quality of life and somatization in patients with long-termlow back pain - A prospective study with 109 patients

Study Design. For this study, a prospective cohort of 109 patients was recr uited consecutively at an orthopedic inpatient unit of a university hospita l. Three self-report instruments were administered to patients with sciatic a believed to be caused by a herniated lumbar disc to examine their quality of life and psychic stress at baseline and at the 1-year follow-up visit. Objectives. To investigate whether patients who have undergone a previous d iscectomy experience greater psychic stress than patients with no surgery, and to determine whether the groups differed regarding their health-related quality of life at the follow-up visit. Summary of Background Data. Previous studies have described psychic abnorma lities in patients with longterm back pain, particularly patients with seve re chronicity (i.e., history of surgeries and persistent problems) or those who underwent a previous discectomy. Additionally, a series of studies has shown that psychic and psychosocial parameters exert a significantly great er influence on the success of treatment than do clinical and imaging findi ngs or the extent of disc abnormality. Methods. The Short Form Health Survey 36, the Symptom Checklist 90, and Scr eening for Somatoform Disorders were administered to 109 patients consecuti vely treated in the authors' orthopedic university clinic, at baseline and at the 1-year follow-up visit. Results. In all the patients examined, the physical and mental quality of l ife improved regardless of their group classification. The psychological di stress, according to the Symptom Checklist 90, was clearly reduced in both groups at the follow-up visit, with the exception of somatization, as indic ated by Symptom Checklist 90 and Screening for Somatoform Disorders. Wherea s the patients who had undergone surgery remained nearly unchanged with reg ard to their somatization, the patients with no previous surgery improved s ignificantly, as indicated by Screening for Somatoform Disorders and Sympto m Checklist 90. Somatization, particularly that surveyed by the comprehensi ve Screening for Somatoform Disorders, proved to be quite a stabile factor over time in both groups. The extent of the physical impairment before trea tment was nearly the same in both groups, as indicated by Short Form Health Survey 36. Despite a markedly higher chronicity of reported problems, pati ents who had undergone surgery were hardly more greatly impaired in terms o f their mental quality of life and psychological distress, as indicated by Symptom Checklist 90, than those without a history of surgery. At the follo w-up visit, the differences tended to be minimal as well. As compared with those who had no previous surgeries, the patients who had undergone surgery were significantly more heavily impaired in their physical quality of life despite significant improvements. Conclusions. Patients with sciatica demonstrated less abnormality in terms of the psychopathologic markers investigated than described in previous stu dies. Nevertheless, the predisposition to somatize influences health-relate d quality of life to a high degree.