Chronic low back pain in a patient with schizoaffective disorder and a remote history of substance abuse: A case report
Author(s): Alexandra Toteva, Kim Heyne*, Ann-Kristin Braun, Fiona Choi, Lena Rademacher, Dianah Hayati, Fatemeh Zibaeenejad, Rishika Daswani, Reinhard Michael Krausz and Gemy Kuriakose
Abstract
The co-occurrence of chronic low back pain and severe psychiatric disorders presents significant diagnostic and therapeutic challenges in inpatient psychiatric settings. This case report describes a 58-yearold man with long-standing schizoaffective disorder, chronic low back pain due to degenerative lumbar spine changes, and a remote history of substance use, admitted for acute exacerbation of depressive and psychotic symptoms. Despite repeated adjustments to opioid-based analgesic therapy following pain consultations, pain relief remained limited and transient; neuroimaging revealed only moderate degenerative changes without nerve root compression. Although the patient engaged consistently in psychotherapeutic interventions and achieved psychiatric stabilization, pain-focused psychological interventions, such as structured pain-coping strategies, were not systematically implemented, and his pain remained persistent, continuing to impede functional recovery. This case illustrates the limitations of predominantly pharmacological pain management in patients with complex psychiatric comorbidity and underscores the importance of early interdisciplinary assessment and structured, pain-focused psychological interventions within psychiatric inpatient care.
