Mental health and Back Pain
Updated: Oct 13, 2022
Back pain is not all about your back, what do I mean by this... the biggest realisation in pain biology research in the past decade is that amount of pain we experience does not necessarily relate to the amount of tissue damage.
Now there is a distinction to be made here, there is acute pain which is caused by injury which signals tissue damage and requires attention and perhaps diagnosis from a GP or medical professional to see if there is damage, disease or inflammation.
And then there is chronic pain or on-going pain which arises time and time again, perhaps without any distinct cause or reason.
No two people will respond to back pain in the same way, even if subjectively they experience the same level of pain, their responses and outlook and ability to recover can be very different.
How can this be?
The different ways in which people respond to their pain is due to people's psychological attitudes, outlooks and life circumstances.
For example; Bob 50, Before he started seeing me for his low back pain he had already started making a number of positive changes to his life, he quit smoking, started going to India to do yoga and meditation and Bob is also in a comfortable economic situation. After a few session which included home care exercises which he did manage to follow through with. Bob has a positive attitude towards his ability to recover.
Mary 38, is taking a break from work as she was feeling overwhelmed and heading for a break down, she was anxious and exhausted and was also raising a young family. She is now beginning to worry about the burden of her husband having to support the whole family. She had been suffering with a similar low back pain as Bob for a number of months having tried a couple of things to resolve it with no luck.
Who do you think has the better chance of recovery?
That's right, it's Bob. That brings us back to our opening statement, your back pain is not just about your back.
Research has shown us that pain is not just due to tissue damage is influenced also by psychological and social factors. This approach has become known as the biosychosocial model or BPS which was first proposed by the psychiatrist George Engel. For those of you who are into yoga this concept might seem not so new to you, when we think about the mind-body connection this really fits into that idea.
This means that pain is heavily influenced by our brain and so our beliefs, feelings , emotional state and sense of control over our circumstances have a massive role to play in the treatment of on-going pain.
And so even if you have back pain that is being medically treated it can be very beneficial to understand how psychological factor impact your pain.
When our physical movement becomes limited this can cause psychological distress, we begin to avoid certain movements fearing that they may cause further injury and therefore more pain, this causes more stiffness and immobility in turn leading to more pain.
We begin to fear the worst case scenario..."I've hurt my back"..."I won't be able to work"..."I'll loose my job"..."I won't be able to feed my family" etc.
Often if there is a pre-existing tendency towards anxiety and expecting the worst this can amplify the pain experience.
Past trauma can be a factor in the experience of pain as well, the ability of the brain to regulate and control emotions and attention can be effected, by the sense of lack of control. Because of this you may loose your ability to control distress, anxiety and may not be able to focus on anything else, which may make the pain seem all consuming.
And it is not just pre-existing mental health conditions which make back pain worse, pain can rewire your brain. According to a study conducted by NIH (National Institute of Health) in the case of people presenting with acute back pain, (remember this is the type of pain that usually relates to tissue damage and generally recovers within 3-6 weeks) brain activity in response to the back pain was limited to a region of the brain that is connected with acute pain, but those with persistent or on going pain showed brain activity in regions connected with emotions. This may explain why anxiety and chronic pain are so connected.
So what can we do?
Thankfully, psychological and complimentary practices can be really helpful with back pain. They help you to work with pre-existing psychological factors, begin to change how you perceive the pain, and also alleviate the psychological factors such as anxiety and catastrophic thinking that maintain your pain.
Mindfulness based stress reduction- which includes...breath practices, body scan, loving kindness meditation, mindful conversations, mindful walks, observing ones emotions, mindful yoga practices which focus more on breathing and feeling rather than achieving a certain pose, modified movements depending on their ability for example chair based yoga.
Cognitive behavioural therapy- This can be helpful, in preventing acute injury from turning into chronic pain.
So let's be clear, though it is evident that the brain is largely involved in our experience of back pain. This does not mean that we are minimising the experience of it, and it is certainly not to say that "it is all in your head" We need to work with the mind, focusing on brain based exercises to change our mindset around pain, practice compassion towards ourselves and retrain the brain through gentle movement to feel safe once again.