Severe unexplained loin pain (loin pain haematuria syndrome): management and long-term outcome
1From the Department of Psychological Medicine, John Radcliffe Hospital, Oxford, 2Regional Pain Clinic, Churchill Hospital, Oxford, 3Pain Clinic, UCL Hospitals Trust, London and 4Institute of Urology and Nephrology, Middlesex Hospital, London, UK
Address correspondence to Dr C.M. Bass, Department of Psychological Medicine, John Radcliffe Hospital, Oxford OX3 9DU. email: christopher.bass{at}obmh.nhs.uk
Received 27 August 2006 and in revised form 2 February 2007
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Abstract |
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Background: The intractable and unexplained loin pain of severe ‘loin pain haematuria syndrome’ (LPHS) causes great psychosocial distress and disability.
Aim: To examine the psychological factors in LPHS patients who had failed to respond to non-opiate analgesia, and explore the feasibility of conservative management.
Design: Retrospective review of case notes, medical and GP records, with follow up.
Methods: We studied 21 consecutive patients referred from specialist renal centres to a regional pain clinic. All records were reviewed, and patients received a comprehensive psychiatric and social assessment. Medication with pain-coping strategies was emphasized, and surgical solutions were discouraged.
Results: Patients' median age was 43 years (range 21–64) and duration of symptoms 11 (1–34) years. Sixteen were receiving opiates, and none had enduring benefit from surgery. Patients were divisible into three groups: twelve (57%) gave a history of recurrent, unexplained symptoms involving other parts of the body (somatoform disorder); seven had chronic loin pain; dissimulation was suspected in two. At follow-up (median 42 months), eight (38%) rated their pain absent or improved. Of the 11 whose pain was the same or worse, all were on opiates and seven had a somatoform disorder. A further two patients had developed ‘other’ medical problems. Despite our advice, three patients underwent major surgery for pain.
Discussion: We recommend that patients be managed in a regional pain clinic, where a multidisciplinary approach promotes self-management of pain. Patients who were able to accept conservative treatment, and taper or withdraw opiate analgesia, had a better prognosis.
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