Time-dependent transformations of the internal image of disorder in patients with chronic back pain

Rationale: Pain is the most prevalent symptom of any disease, with back pain comprising 12 to 33%. Chronic back pain ranges fourth among the causes of disability. About 60% of patients with chronic pain have symptoms of depression. However, there is paucity of empirical data on psychological aspects of the pain syndrome chronization in patients with back pain. 
Aim: To study the temporary transformation of the internal image of disorder in patients with chronic back pain. 
Materials and methods: In this observational cohort analytical study, we evaluated the contribution of pain duration into the formation of the internal image of disorder in 84 patients with chronic pain lasting for up to 55 years and caused by dorsopathy. The patients (53 women and 31 men aged 23 to 86 years, with pain intensity of up to moderate degree) were those admitted to an in-patient department for the secondary medical rehabilitation. The internal image of disorder was operationalized with the following psychometric scales: McGill Pain Questionnaire, the Restoration of the Locus of Control Scale, the Tampa Scale of Kinesiophobia, and the Psychological Factors of Attitudes to the Disease and its Treatment Scale. 
Results: The sensory level of the internal image of disorder was characterized by mixed (neuropathic and dysfunctional) pain in 29 (34.5%) of the cases and nociceptive pain in 55 (65.5%) of the cases. In the patients with nociceptive pain, the duration of pain was negatively correlated with their perception of self-efficacy towards the disease (the intellectual level of the internal image of disorder). With time, their self-confidence and the ability to get rid of pain was decreasing (R = -0.32, p = 0.02). The decrease looked like waning fluctuations with a maximum decline rate in the second year of the disease. 
Conclusion: During the first year from the disease manifestation, patients with nociceptive pain are convinced that they have all necessary resources to cope with the disease; mandatory psychological support should be provided to them in the second year, with a dramatic drop of their self-efficacy. As for patients with mixed types of pain, the inclusion of sessions with a medical psychologist into their individual rehabilitation plan is advisable regardless of the duration of the pain syndrome.