El cirujano ortopédico ante las lumbalgias «sin hallazgos»

The «low-back pain» without clínical findings is used for those patiens whose only complaint is pain on the back without any further clínical evidence; every day, a greater proportion of these patients is seen in the Orthopaedic OutPatient Department, and paradoxically, not in psiquiatric consultations. The psicologal meaning of the back in the interpretation within the «bod scheme»is considered. The pain ways from the peripherial receptors to the brain and the role of «gate control» (Melzack and Wall) allows the pain as sensation and the pain as suffering to be distinguished. The biological significance of the pain and itspsicological development are being studied. From the cybernetic point of view, the pain could be considered as a «noise» in the cybernetic circuito Serotonine is the neurotransmiter on the «gate control» and also its low level in bIood is found in all states of depressión.Examination by psicologal tests show an state of anxiety and anguish in these patients.The patients deny any psicological problem, because the «complaint» has resolved the conflicto The psicological profile of these patients is characterized by a difficulty to personal relation ship and conlunication, a guilt complex and the consideration that the· pain is the way to achieve expiation. The sociological factors of modern life have increased the amount of these«pain-prone» patients. The pain is «behaviour response» using a «learning model» taken out of work and family atmosphere. There are chronic «painprone » patients and occasional ones. The orthopaedic consultants should be prepared to pay attention to these patients who are asking for surgical treatment, to which they look forward as a punishment. The psicotherapy carried out by the psichiatrists usually fails in these patients, and also the treatment in the «Pain Unit» as well as the hypnosis.Our aim to be valuable should be a patient anamnesis, a careful spine exploration to exclude any organic damage, the use of medication with chlordiazepoxides and amitriptyline, and to be prepared to attend them during many visits, because they need the «pain» and us to arrange their lives.

The «low-back pain» without clínical findings is used for those patiens whose only complaint is pain on the back without any further clínical evidence; every day, a greater proportion of these patients is seen in the Orthopaedic OutPatient Department, and paradoxically, not in psiquiatric consultations. The psicologal meaning of the back in the interpretation within the «bod scheme»is considered. The pain ways from the peripherial receptors to the brain and the role of «gate control» (Melzack and Wall) allows the pain as sensation and the pain as suffering to be distinguished. The biological significance of the pain and itspsicological development are being studied. From the cybernetic point of view, the pain could be considered as a «noise» in the cybernetic circuito Serotonine is the neurotransmiter on the «gate control» and also its low level in bIood is found in all states of depressión.Examination by psicologal tests show an state of anxiety and anguish in these patients.The patients deny any psicological problem, because the «complaint» has resolved the conflicto The psicological profile of these patients is characterized by a difficulty to personal relation ship and conlunication, a guilt complex and the consideration that the· pain is the way to achieve expiation. The sociological factors of modern life have increased the amount of these«pain-prone» patients. The pain is «behaviour response» using a «learning model» taken out of work and family atmosphere. There are chronic «painprone » patients and occasional ones. The orthopaedic consultants should be prepared to pay attention to these patients who are asking for surgical treatment, to which they look forward as a punishment. The psicotherapy carried out by the psichiatrists usually fails in these patients, and also the treatment in the «Pain Unit» as well as the hypnosis.Our aim to be valuable should be a patient anamnesis, a careful spine exploration to exclude any organic damage, the use of medication with chlordiazepoxides and amitriptyline, and to be prepared to attend them during many visits, because they need the «pain» and us to arrange their lives.