Psychosomatic Medicine 14:18-33 (1952)
© 1952 American Psychosomatic Society

Life Situations, Emotions, and Backache

¹ Departments of Medicine and Psychiatry of the New York Hospital and Cornell University Medical School. Supported in part by grants from the Commonwealth Fund, the estate of Lester N. Hofheimer, and the New York Telephone Company; Department of Psychiatry, University of Washington School of Medicine, Seattle, Washington
² Departments of Medicine and Psychiatry of the New York Hospital and Cornell University Medical School. Supported in part by grants from the Commonwealth Fund, the estate of Lester N. Hofheimer, and the New York Telephone Company

Patterns of skeletal muscle participation in the behavior of 65 subjects with backache and 10 without backache have been studied and the following inferences drawn:

A pattern of skeletal muscle hyperfunction characterized by a generalized and sustained increase in motor and electrical activity was a common accompaniment of the reaction of subjects exhibiting the backache syndrome to situations which threatened their security and engendered apprehension, conflict, anxiety, and feelings of resentment, hostility, humiliation, frustration, and guilt.

This pattern of skeletal muscle hyperfunction appeared to be an integral component of an "action" pattern of behavior utilized extensively by the subjects exhibiting the backache syndrome in their attempts to achieve satisfactory interpersonal and social adjustments and maintain their security.

Generalized and sustained skeletal muscle hyperfunction occurring as part of an individual's reaction to a threatening life situation engendering conflict, anxiety, and other strong emotions was often provocative of pain in the back, neck, and extremities.

Strenuous activity and trauma appeared to have enhanced etiologic significance in the genesis of the backache syndrome when they took place in the setting of a threatening life situation because of difficulties in social and interpersonal adjustments which engendered generalized skeletal muscle hyperfunction.

It is postulated that the mechanisms involved in the production of the pain in the backache syndrome include: 1) relatively intense and sustained skeletal muscle activity with the elaboration of a noxious tissue metabolite--"Factor P" of Lewis--and 2) a state of relative ischemia of the hyperfunctioning muscles which engenders the gradual accumulation in the tissue spaces of "Factor P" to a concentration sufficient to exceed the pain threshold.

The genesis of the backache syndrome appears related to the inappropriate utilization of a protective reaction pattern involving the participation of the skeletal musculature in an "action" pattern of behavior designed to facilitate attempts at interpersonal and social adjustments.

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