Psychogenic Low-back Pain and Hysterical Paralysis in Adolescence.

STUDY DESIGN: A retrospective review.

OBJECTIVE: The purpose of this study was to investigate the clinical outcomes in adolescents diagnosed with psychogenic low-back pain and hysterical paralysis and to evaluate the efficacy of differential diagnosis methods.

SUMMARY OF BACKGROUND DATA: The incidence of low-back pain in adolescence is similar to that in adults, but the causes of low-back pain are difficult to determine in most cases. For these patients, a definitive diagnosis of psychogenic low-back pain and hysterical paralysis as well as adequate treatment are clinically important to avoid unnecessary surgical treatment.

METHODS: Eleven patients [3 males and 8 females; mean age, 16.5 years (range, 13-19 y)] diagnosed with psychogenic low-back pain and hysterical paralysis were followed up for 2-10.25 years (mean, 4.67 y). Nonorganic signs were observed in almost all patients. For the purpose of excluding organic disorders, the thiopentone pain study was used in patients who complained mainly of pain, and motor evoked potentials (MEPs) using transcranial magnetic stimulation were measured in patients experiencing primarily muscle weakness.

RESULTS: The psychiatric diagnosis was neurosis in 9 patients, whereas it was psychosomatic disorder in 2 patients. Conservative treatment, such as physiotherapy, was performed, and at the final follow-up evaluation, outcomes were regarded as excellent in 7 patients and good in 4 patients.

CONCLUSIONS: The prognosis of psychogenic low-back pain and hysterical paralysis in adolescence is relatively good. However, it is important to understand the characteristics of psychogenic low-back pain and hysterical paralysis in childhood and young adulthood and to perform accurate diagnosis via screening for nonorganic signs and excluding organic disorders by using the thiopentone pain study and MEPs obtained using transcranial magnetic stimulation.