Low blow Lower-back-pain sufferers, brace yourselves: A new study out of Stanford University School of Medicine says your pain may be tied more to psychological distress than to structural problems.

Who's next? Researchers gathered 96 participants: men and women, average age 44, none of whom had lower back pain -- yet. They examined the individuals' spines for cracks or tears in the spongy cartilage disks whose deterioration can trigger back pain. Forty-six people also had dye injected into the disks, to see if pain associated with the common procedure was predictive of later problems. All participants also underwent psychological evaluations.

Painful facts After four years, psychological rather than physical observations more accurately predicted disabling lower-back pain. Those found to have poor coping skills were nearly three times more likely to report severe back pain, take medicine for it and lose time at work for it than those with good coping skills. Lead study author Eugene Carragee, professor of orthopedic surgery at Stanford, hypothesized that good copers took occasional lower-back pain in stride. Poor copers felt much more troubled and overwhelmed by it.

Now what? Three-quarters of the 300,000 spinal fusion operations performed each year are done for back pain that is presumed to be caused by disk degeneration, Carragee said. He hopes his study will spur doctors first to rule out serious structural disorders, then ask patients if they're stressed and if they have friends and family to help them cope. If not, he says, rehab and psychological support may bring better relief than surgery.

-- Suz Redfearn