Emotional stress and chronic back pain

About 80% of us will experience back pain at some point, and for many people this becomes a long-term problem. After a visit to the GP, they’ll probably take painkillers and anti-inflammatories, and try to get on with their lives.  Some chronic sufferers may be offered surgery to help deal with the pain.

However, despite the advances in diagnostics, medications and surgery, many people are never free of back pain. Around 1.6 million Britons develop chronic back pain each year, and about half of them find the pain disabling.

Most pain specialists accept that when pain moves from a short-term problem to becoming chronic and long term, psychological factors can then be part of the problem, and often make things worse. In fact, guidelines from NICE (National Institute for Clinical Excellence) recommend that a cognitive behavioural approach is part of the treatment for low back pain and sciatica, especially when the pain is persistent, or other methods have not worked.

However, some professionals working with chronic back pain go much further. Professor J. Sarno in the 1990’s, and more recently physiotherapist Nick Sinfield, argue that while our attitudes can certainly make the pain worse, the primary cause of much chronic back pain is emotional stress and tension.

Medical professionals are trained to see back pain in terms of injury or damage to the spine. They have sophisticated technology and techniques to detect any abnormalities in the physical structure of the back, which are then assumed to be causing the problems. Because the pain is physical, the cause is also thought to be physical.

However, most of us over the age of 20 will have structural abnormalities in our backs. This is due to normal wear and tear, and the inevitable degeneration caused by aging. These do not necessarily cause any problems; our backs are essentially robust. The messages that we are given however encourage us to view our backs as fragile and easily damaged. We may worry excessively about any back pain.

Another factor is that when many individuals suffer emotional disturbance or trauma, they experience a range of emotions that they can’t easily deal with. These emotions are then repressed and avoided. Over time, these repressed emotions can cause anxiety and defensiveness. Whenever this anxiety is exacerbated, it can create a range of physical symptoms such as gastrointestinal problems, skin disorders, and chronic tension and pain, especially back pain.

Years of chronic tension in the back cause the structure of the back to tighten and change – restricting blood and oxygen supply. Muscles deprived of oxygen can build up deposits of lactic acid, triggering pain, spasms, tingling and numbness. This pain can also be confused with the pain experienced during previous episodes of back injury.

Because of this widespread view that our backs are fragile, and that the cause of back pain is only physical, many people may be reluctant to recognize that emotional factors could also be important. There may also be the sense that this would somehow indicate they are emotionally weak. This is just another aspect of the pervasive stigmatisation of any form of mental disturbance or illness.

Dealing with chronic back pain:

• Accept that emotion and anxiety may play an important role in your chronic back pain, deal with any unresolved issues and unhelpful beliefs, and learn a more relaxed and confident attitude, both emotional and physical – CBT and hypnotherapy can be very effective here.
• Deal with muscular imbalances and stiffness, and develop better posture and body use – physiotherapy, osteopathy, massage and other bodywork techniques are very useful.
• Daily appropriate stretching exercises – get professional advice, and gentle yoga and Pilates classes will be very helpful.

I’d be very pleased to give you more information, and to answer any questions.