Learned helplessness and responses to nerve blocks in chronic low back pain patients

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Abstract
In a double-blind study, 67 chronic low back pain patients received 4 lumbar sympathetic nerve blocks, 2 given with bupivacaine and 2 given with saline. Hypothetically, patients showing evidence of learned helplessness, as measured by dependence on habit-forming medications for the pain, low activity levels and elevated MMPI [Minnesota Multiphasic Personality Inventory] scores on hypochondriasis, depression and hysteria would show the least reduction in subjective pain intensity following injections with both bupivacaine and saline. Placebo responses should be greatest in patients who had a high educational level, were divorced and had no pending disability claims. Responses 30 min following nerve blocks failed to correlate with these variables. Decreases in subjective pain intensity 24 h following both types of nerve blocks were greater in patients who showed low levels of pain behavior, who were divorced and who had no pending disability claims. Decreased pain 24 h following saline injections was significantly related to low scores on the lie, defensiveness, hypochondriasis and hysteria scales of the MMPI and to reduced subjective pain intensity following a 6-wk comprehensive outpatient pain rehabilitation program. Chronic pain patients who are fixed in their focus on pain, high in pain-related behaviors and low in responsibilities are less likely to respond favorably to nerve blocks. Medical treatment for them needs to be paired with therapies designed to reduce their helplessness.