Is Your Back Pain All in Your Head?

Chronic low back pain (CLBP) is not picky. Like an equal opportunity employer, it chooses all ethnicities and excludes no genders. “The prevalence of CLBP in adults has increased more than 100% in the last decade and continues to increase dramatically in the aging population … with a significant impact on functional capacity and occupational activities.”ⁱ

And guess what? In many cases, it’s not a disease or physical injury that’s causing the ongoing pain. While an episode of low back pain from a car accident or moving the wrong way during a vigorous workout with free weights may be the starting point, there is increasing recognition that psychosocial factors can interfere with recovery from a short-term back problem. This compounds the problem with the result that the pain is aggravated and prolonged. If a doctor doesn’t ask about the emotional, financial, relationship and attitudinal stressors in the patient’s life, it’s not likely that medications, massage, physical therapy, etc. will quickly ease the problem. Or, if they do, it shouldn’t be a surprise if pain returns or even becomes chronic.

The mind-body connection

We live in a high-tech, high-pressure, fast-paced world. Growing up, many of us were discouraged from expressing feelings. Thus, as adults we may not have good ways to vent. Instead, we walk around with suppressed needs and tensions. This affects us mentally and psychologically. In turn, muscles become tense, release of hormones changes blood sugar and leads to inflammation in the body as well as affecting our heart rate and digestive balance. As health worsens and the immune system is undermined, it further erodes our ability to cope. It’s not just “all in your head.” And it’s a vicious circle.

Physical consequences, including pain, build up when we’re too busy or too untrained to listen to what’s pent up inside. Think of common expressions that use physical images to hint at inner stress:

• She’s a pain in the neck
• I need to take a load off
• This job is just one headache after another
• Dealing with the IRS is a pain in the ass
• Poor guy, he has to shoulder his family’s burdens

Inner factors that make back pain linger

Here are some common psychological factors or stressful situations that contribute to CLBP:

1. Depression – In today’s world, the majority of people who are dealing with depression are not mentally ill. Think of how many people were affected by the sub-prime mortgage crisis, or who are struggling financially for other reasons. How about the high divorce rate? Concerns about teens who are addicted to their smartphones or whose social life exists in virtual reality on social media? In fact, it’s depressing just to write about all these concerns! Think about how depression manifests in stooped or slouched posture – things that lead to osteoarthritis of the spine or other physical back problems.
2. Passive coping strategies – When life piles on lists of responsibilities, it often becomes easier (in fact, a relief) to dodge or duck them. Instead of mustering the will and resources to behave proactively, people sometimes cope passively and hope to ride out the situation. However, there are unwanted or unforeseen consequences that will eventually catch up. Loss of a marriage, a job, property…these are fairly catastrophic, but even less dramatic outcomes can end up creating far more stress than the original responsibilities entailed.
3. Psychological distress – Everyone has problems, yet there are times in life when we don’t cope well with them. When the human mind starts swirling with anxiety, fear, anger, frustration, etc. psychological pressures build. If you have ever felt yourself carrying tension in your shoulders, or experienced frequent gastrointestinal distress, you can be sure that the muscles of your core and lower back are also involved. Muscle tightness due to psychological or emotional distress impedes circulation and increases inflammation. These are counterproductive when the body is trying to heal itself, especially if it’s a back injury involving tendons, ligaments, muscle groups, and the spinal column.

These are just three factors, but there are more. If you’re a victim of chronic lower back pain, you may live with it far too long, thinking “I don’t have time to see a doctor” or “maybe tomorrow these pills will finally work” as you struggle to get comfortable in bed for the umpteenth time. Want suggestions?

• Make a doctor appointment. No matter how busy you are, you are losing more efficiency and productivity by concocting ways to push past the pain that is trying hard to get your attention.
• The physical pain is real. However, if you are honest with yourself, you know what’s weighing you down and eating away at you. If the doctor doesn’t ask, bring it up. In fairness to yourself and the doctor, knowing the whole story is the starting point on the map to wellness.

A painful back may be a good friend in helping you bring inner psychological pain to the surface. The pain itself is not all in your head, but perhaps more is going on in there than you recognize. Chronic back pain is a stern communicator, so listen to what your body is trying to tell you.

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ⁱAllegri M, Montella S, Salici F, et al. Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Research. 2016;5:F1000 Faculty Rev-1530. doi:10.12688/f1000research.8105.2.