Chronic low back pain: Symptom or no symptom?

This article examines a psychological aspect involved in some somatic disorders, in particular chronic back pain. Several cases of patients with low back pain received in psychotherapeutic interviews show that the status of pain changes, depending on whether they consider that it has symptom value or not, in the psychoanalytical sense. The "choice" of this status is personal, subjective, unconscious, and has an impact on the development of LBP. After defining the symptom in the medical sense and in the psychoanalytical sense, and pointing out the distinction between hysteria and psychosomatic, the authors present their approach to the link between the body and the psyche according to the Mobius strip model used by Lacan to define the relationship between the conscious and the unconscious. However, it is illusory, that general medicine can lead all patients to make their back pain a "psychoanalytical" symptom. The context and the setting are different because the patient who consults his doctor does not expect the same as he who goes to a psychologist, a psychoanalyst or a psychiatrist. Nevertheless, that people open to the possibility of an evolution of the patient based on a change in his subjective position may be an important advantage, because what is in play in the process of chronicity is not only the disappearance of chronic pain, but the change of its function for the subject, that is to say the way from the first function of pain as dangers' signal to the second that permits an elaboration of a subjective sense. And for that, it is necessary that the patient as well as the practitioners concerned recognize this second function. (C) 2010 Elsevier Masson SAS. All rights reserved.