Physical findings in patients with chronic intractable benign pain of the neck and/or back

Hubert L. Rosomoff, David A. Fishbain, Myron Goldberg, Ramon Santana, Renee Steele Rosomoff

Research output: Contribution to journalArticle

66 Scopus citations

Abstract

Chronic intractable benign pain (CIBP) is defined as non-neoplastic pain of greater than 6 months duration without objective physical findings and known nociceptive peripheral input. To test the CIBP concept, 283 consecutive chronic pain patients were examined independently by a neurosurgeon and physiatrist and only congruent physical findings were coded. Because they did not fit the CIBP definition, patients with the following primary treatment diagnoses were eliminated: degenerative disease of the spine and spinal stenosis; degenerative disease of the hips; radiculopathy; malignancy; deafferentation pain; and miscellaneous. Eliminated, also, were patients with any one finding indicative of a root compression syndrome, leaving 90 low back and 34 neck patients. These patients had abnormal physical findings in 7 categories: tender points/trigger points; decreased ranges of motion in back or neck; non-anatomical sensory loss; rigid musculature; decreased range of hip motion; gait disturbance; and miscellaneous non-neurologic signs. Low back CIBP patients had the following distribution among the 7 categories: 0% had findings of all 7; 1.1% had 6; 13.3% had 5; 24.4% had 4; 25.6% had 3; 26.7% had 2; 8.9% had 1; and 0% had none. Neck CIBP patients, in which only the first 4 categories of physical findings were applicable had the following distribution: 2.9% had 4; 41.2% had 3; 35.3% had 2; 20.6% had 1; and 0% had none. It was concluded that CIBP patients do have abnormal physical findings indicative of musculoskeletal disease: possibly fibrositis and/or specific myofascial syndromes, as sources of peripheral nociception. These findings question the validity of the CIBP concept and point to the need for a careful, all-inclusive physical examination as a basic initial requirement in the classification of chronic pain patients.

Original languageEnglish (US)
Pages (from-to)279-287
Number of pages9
JournalPain
Volume37
Issue number3
DOIs
StatePublished - Jun 1989

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Keywords

  • Chronic intractable benign pain
  • Neck and/or back pain
  • Physical findings

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health
  • Neuroscience(all)
  • Neurology
  • Pharmacology
  • Clinical Psychology

Cite this

Rosomoff, H. L., Fishbain, D. A., Goldberg, M., Santana, R., & Rosomoff, R. S. (1989). Physical findings in patients with chronic intractable benign pain of the neck and/or back. Pain, 37(3), 279-287. https://doi.org/10.1016/0304-3959(89)90192-9