Low back pain is one of the most common problems healthcare professionals see. In fact, four out of five adults will experience a serious episode of low back pain at some point in their lives. Fortunately, the majority of patients with low back pain will successfully overcome their discomfort and return to their normal work and community lives within 2–4 months, often without treatment.
Emotional reactions to sudden back pain are absolutely normal. These reactions include fear, restlessness/tension, and sadness about what the pain means, how long it will last, and how much it interferes with activities of daily living. In fact, pain is a complex experience that includes both physical and psychological factors.
Indeed, in 1979, a large professional organization specializing in pain—the International Association for the Study of Pain—offered the most widely used definition of pain: “with actual or potential damage. unpleasant sensory and emotional experience associated with or described in terms of such damage.” The emotional or psychological aspect is an integral part of the entire experience of pain and it is normal to abstain from the activity that causes the pain. However, taking an active role in coping with pain and participating in doctor-guided activities are key steps in recovery.
There are currently accepted clinical principles for the treatment of low back pain and its associated stress, along with the control of onset pain (within the first 10 weeks of pain). Based on these principles, the following matters are important:
Addressing patients’ fears and misconceptions about low back pain
Providing a logical explanation for pain and expected outcome
Simple exercises given and their level gradually increase. empowering the patient to continue/resume normal activities of daily life through increased activity
This should be supplemented, if necessary, with complementary therapies such as pain medications, manual therapy, and/or physical therapy for symptomatic relief.
QUESTIONS TO ASK
To minimize your emotional stress, it’s important to ask your healthcare provider questions about your low back pain so you’re not suspicious or anxious when you leave your specialist’s office. Understanding your pain will help reduce your anxiety. Also, keep in mind that if your pain lasts longer than 2–4 months (considered the normal recovery time for many back pain problems), your condition may become chronic. Chronic pain may even be linked to greater psychological distress.
During the acute phase, feelings of helplessness, stress, and anger towards your healthcare professional (for your pain persists) may occur. To help alleviate this distress, you need to make sure your healthcare professional is taking care of all your important psychological and physical needs. You and your healthcare provider should provide:
You should express your thoughts about your pain symptoms. It is normal for patients to fear a serious illness or disability. Make sure your healthcare provider addresses your fears through medical evaluation and, if necessary, medical testing to rule out serious conditions.
Make sure your healthcare professional explains exactly what he is looking for and eliminating during this evaluation and testing, and you will get results in language you can understand.
If your healthcare provider recommends staying active, be sure to talk to you about how you can stay active safely.
Inform your healthcare provider of any functional difficulties (eg, bending over, lifting, etc.) caused by your pain, and jointly identify ways to overcome these difficulties. Have your healthcare professional address any problems you experience while doing your normal work activities.
The information you receive about the diagnosis and the course of your disease should be in a way that you can understand. Make sure you understand the natural course of low back pain, what improvement can be expected, and when the condition may begin to improve.
Whenever a recommendation is made, make sure you or your healthcare professional write it down so you can review it after you leave your specialist’s office.
THE RELATIONSHIP BETWEEN STRESS AND PAIN
All of these recommendations are aimed at reducing the emotional issues and stress that many patients experience with pain. If you are not satisfied with the treatment and the explanations given, consider getting a second opinion from another healthcare professional. Worry and stress can indeed increase your perception of pain and decrease your ability to cope with pain.
It is important to remember that there is a dynamic relationship between your mood (eg, your level of anxiety) and your physical state (eg, pain). Pain causes stress, stress causes more pain, and so on. The longer this vicious cycle lasts, the more your emotional pain will tend to increase. This cycle can be very difficult to break.
Emotional suffering can lead to insomnia, an inability to work, and feeling irritable and helpless about what to do. You may feel hopeless and try to relieve the pain no matter what, including medical (surgical?) interventions. While interventional approaches may be helpful for some conditions (eg, herniated disc), such approaches can be avoided if pain and stress are treated at an early point.
PSYCHOLOGICAL INTERVENTION FOR LOWER PAIN
Reassurance from your education and healthcare professional can be very helpful in preventing or relaxing much of your stress and anxiety. You also need to be effective in your condition and treatment. These naturally occurring feelings of anxiety and stress can cloud your judgment. Your goal is to avoid getting into a chronic pain cycle. Your healthcare provider’s reassurance that the pain is temporary will help you avoid constant preoccupation with the pain and avoid unnecessary worry about the symptoms.
Fortunately, there are many psychological treatments that have been used successfully to treat pain and anxiety. These are stress management, relaxation training, biofeedback, hypnosis, and cognitive behavioral therapy (a method used to reduce feelings of helplessness and hopelessness). Medications are also available to help with sleep problems, anxiety, and depression. Comprehensive pain management programs integrated with your medical care can certainly be very helpful as well.
Your healthcare provider may refer you to a psychology management program if deemed necessary. Participating in this type of program doesn’t mean it’s “all in your head”, it means teaching you how to deal with pain. Remember that pain is an experience that involves a close interaction of physical and psychological factors! But together, you and your healthcare professional can help manage and overcome your pain.
