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    Back Pain Test Not Proof of Spine Trouble

    Mental, Social Distress Predicts Pain Better Than Disc Injection Test

    Back Pain Not All in the Head

    This doesn't mean back pain is all in a person's head. Without some kind of degenerative process going on in the back, Carragee says, back pain is unlikely. But psychological and social issues seem to have a great deal to do with how disabling that pain becomes.

    "If you have the best job and best family in the world and lots of money and have common backache, the pain might not be on your radar screen," Carragee says. "But if you hate your life, and your family life is bad, and you have a vendetta going on with your employer, and have a backache, that turns into a very different experience."

    People under psychological and social stress don't imagine their pain. But their difficulties may make them hypersensitive to ongoing pain, Carragee suggests.

    "If you don't have any degenerative process in your back, then getting a back-pain problem is unlikely," Carragee says. "It looked as though the psychosocial issues were permissive. You have to have something physical to get the backache. But whether that is a big deal seems to have to do with your psychosocial resources."

    Rehabilitation specialist Michael K. Schaufele, MD, assistant professor at the Emory University spine center, says Carragee's study raises some good points. He notes, however, that doctors never perform discographic injections on people who aren't in pain. When used properly, he says, it's a good way for a surgeon to pinpoint a person's back problem.

    But proper use of the technique means screening out patients who are not good candidates for back surgery.

    "Patients in psychological distress are not candidates for surgery," Schaufele tells WebMD. "So if you have someone with a clear anxiety disorder or depression, you should not send them to discography."

    Schaufele agrees with Carragee that in people who tend to experience their psychological distress as physical pain, doing more and more medical procedures is counterproductive.

    "One of the problems is the more needles you stick into people and the more procedures you do, the more you feed into their illness," Schaufele says. "You keep acting as if their problem is purely physical -- but if someone is in psychological distress, that is not something you want to do."

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