Psychological approach to chronic low back pain

Kronična križobolja jedan je od najčešćih oblika kroničnog bola, među najčešćim je povodima onesposobljenosti i izostanaka s posla i među najčešćim razlozima traženja liječničke pomoći. Usprkos brojnim suvremenim metodama liječenja, oko 30 % bolesnika s akutnom križoboljom prelazi u kategoriju kroničnog bolnog sindroma, pri čemu bol preuzima dominaciju nad životom bolesnika, njegove obitelji i bliže socijalne okoline, te oštećuje kvalitetu života. U skladu s biopsihosocijalnim modelom aktualno je stajalište da psihološke čimbenike treba sagledati kao važne odrednice u doživljaju bola i ponašanja. Psihološki procesi nisu samo reakcija na bol, nego i integralni dio doživljavanja bola. U članku se razmatra djelovanje psiholoških čimbenika koji uključuju crte ličnosti, emocionalna stanja, kognitivne i ponašajne obrasce, stresore i mehanizme suočavanja, te daje kratak prikaz postavki pojedinih psiholoških modela razvoja kroničnog bola. Budući da neprepoznate i neliječene psihološke poteškoće mogu značajno negativno interferirati s uspješnošću rehabilitacije bolesnika s križoboljom, predlažu se načini probira koji mogu poslužiti kao smjernice u identificiranju bolesnika kojima je potrebna stručna psihološka pomoć. Evaluacije psiholoških tretmana pokazuju najveću učinkovitost kognitivno-bihevioralnog i samoregulirajućih tretmana (biofeedback, relaksacija i hipnoza) u unapređivanju emocionalnog i fizičkog funkcioniranja, reduciranju specifične onesposobljenosti povezane s bolom, smanjenju depresije, poboljšanju kvalitete života, smanjenju broja posjeta liječniku i upotrebe lijekova za suzbijanje bola, kao i trajanja bolovanja. Prema suvremenom imperativu interdisciplinarnog programa rehabilitacije bola u svakodnevnoj bi praksi trebalo težiti ka ostvarivanju uvjeta za simultane intervencije fizijatra, fizoterapeuta i psihologa. Takav način rada pokazao se najučinkovitijim pristupom u liječenju križobolja.Chronic low back pain is the most common form of chronic pain, one of the most common causes of disability and work absence, and the most common reason for requiring medical help. Despite of numerous contemporary methods of medical treatment, about 30 % of acute low back patients make a transition to chronic pain sindrom which makes pain dominant over patient’s life, his/her family and close social surroundings and also impairs the quality of life. A recent scientific view, in accordance with biopsychosocial model, is that psychological factors are important determinants of pain perception and behaviour. Psychological processes are not only a reaction to pain but also a part of integral pain perception. This article considers the effects of psychological factors which include personality traits, emotional states, cognitive and behavioural patterns, stressors and coping strategies, and it also gives a short overview of certain psychological models of chronic pain development. Whereas unrecognized and untreated psychological difficulties may have a significantly negative influence on efficacy of low back patient’s rehabilitation, there are several proposed guidelines for the identification of patients that need professional psychological help. Evaluations of different psychological treatments emphasize the results of cognitive behavioural tretament and self-regulation treatments (biofeedback, relaxation and hypnosis) as the most efficient in the improvement of emotional and physical functioning, pain and disability reduction, decrease of depression, enhancement of the quality of life, reduction of the number of visits to physician and the intake of pain relief pharmacotherapy, as well as in cutting down the period of work absence. According to the contemporary imperative of interdisciplinary pain rehabilitation programs, simultaneously implemented interventions of multidisciplinary teams which include a physician, a physical therapist and a psychologist, are emphasized as the most efficient approach to the treatment of low back pain patients