Contact: Donald S. Ciccone, PhD
(973) 972-2080
cicconds@umdnj.edu

Back Pain and Its Benefits

Instead of making life easier, disability payments and other economic benefits are associated with increased disability and depression in persons with chronic nonmalignant back pain, new research by scientists at the University of Medicine and Dentistry-New Jersey Medical School shows.

Social reward like sympathy from a solicitous spouse or being excused from performing household chores was also associated with increased disability and depression.

In addition, social reward was linked with patients' reports of higher levels of pain and a greater number of nonspecific medical symptoms, according to the study published in the current issue of Psychosomatic Medicine.

"We found that both social and economic rewards were associated with significant differences in behavior. In general, higher levels of reward were associated with higher levels of disability and depression," said Donald S. Ciccone, PhD, principal investigator on the study. "However, our study was not designed to establish a cause and effect relationship. We simply documented a strong association or correlation between reward and various measures of illness behavior."

Ciccone and his colleagues selected 75 patients with chronic nonmalignant back pain and assigned them to one of four separate groups ranging from low/economic/low social reward to high/economic/high social reward on the basis of their responses to a survey about their current economic and social circumstances.

The researchers found:

• Patients who reported multiple sources of economic reward as a result of their illness had higher levels of back pain and disability than did patients with one or no sources of economic reward.
• Each increase in economic and social reward was associated with a corresponding increase in disability.
• Patients in the high social reward group were more disabled, more distressed and reported higher levels of pain than did those in the low social reward group.
• Patients in the high economic group missed more days from work and were more depressed than patients in the low economic group but did not report higher levels of pain overall or complain of more general medical symptoms.
• High levels of economic and social reward were associated with increased depression. Persons with fewer rewards reported lower levels of depression.
• Patients with high levels of social reward were more likely to report anxiety than patients with low levels of social reward.

The economic reward scale used in the study was based on self-reported workman's compensation benefits, Social Security disability benefits, other disability income such as private insurance, court settlements and financial assistance from family or friends.

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Psychosomatic Medicine is the official peer-reviewed journal of the American Psychosomatic Society, published bimonthly. For information about the journal, contact Joel E. Dimsdale, MD, at (619) 543-5468.