“But is all this pain just caused by stress?” This is one of the most frequent questions you ask me in consultation. While the other day we were talking about low back pain, its physical causes and treatments. Today I asked Beatriz, the psychologist who collaborates with us about the relationship between low back pain and stress, and this is the post she wrote for us:
what is low back pain?
As shown by the WHO, low back pain is the main cause of disability worldwide and the origin of 1/3 of the cases of sick leave due to disability. Furthermore, it has been shown that low back pain is one of the pathologies that can last the longest, prolonging disability for several years. It is estimated that between 70 and 90% of the people in the world will suffer low back pain at some time in their lives: between 5 and 25% will do so annually, while 50% will do so at working age.
Low back pain is considered to be a pain or set of pains located between the last rib and the gluteal area, which may spread to the extremitiesand have their origin in an underlying alteration, which is usually muscular, traumatic or of a non-mechanical type, such as those caused by a tumor.
There are occasions in which in spite of an exhaustive evaluation, both with imaging tests and other evaluations, no demonstrable cause of the pain is found. In these cases, it is interesting to assess whether there is any emotional or stressful aspect in the patient’s life that may be generating this pain. This does not mean, as people often tend to think, that the pain does not exist and that we are inventing it, but rather that despite the fact that there has been no blow, no overexertion, etc., we do find that the entire muscular area is under tension and with contractures typical of low back pain.
The fact that there is no physical cause does not mean that we are inventing the pain, but rather that, in spite of there being no probable physical cause, we find that whole muscular area in tension and with active contractures typical of low back pain.
Relationship between emotions and pain
Emotions and emotional experience are closely related. If we get technical, some models explaining the Emotion-Pain relationship have found a strong relationship between the nociceptive modulation system (i.e. the system that regulates when, how and how much pain we feel) and the neurochemical substrate of emotions (i.e. the changes we undergo at brain level to generate and feel emotions). These models have observed that these brain changes produced by emotions favor or hinder the regulation of the system that controls pain, causing us to suffer more or less pain depending on the emotion we feel at the time.
If we analyze the way we feel when we have been feeling pain for a long time without improvement (what is known in psychology as the “affective component of chronic pain”) we find a whole range of mostly negative emotions. Depression, anxiety and anger in the face of chronic pain stand out. In turn, this depression, anxiety and anger are related to the creation, maintenance and increase of pain, causing us to suffer more pain, in a more sustained and intense manner.
Mª Magdalena Truyols, Mª Magdalena Medinas et al. did a very interesting study on this relationship between low back pain and depression, anger and anxiety (if you want to read the original study, click here). In it, they found that patients with chronic low back pain scored higher in depression, stress and anxiety. Although it was not statistically significant, they also found that patients with chronic low back pain scored higher in Anger, so they showed a general propensity to experience and express it without provocation. It is noteworthy that women suffer more from these negative emotional states than men.
The brain changes produced by emotions favor or hinder the regulation of the system that controls pain, causing us to suffer more or less pain depending on the emotion we feel at the time.
Relationship between emotions and contractures
Many reviews have been made on the relationship between emotional factors, stress and the pain produced by low back pain. In the first place, it is known that emotional factors have a powerful influence on low back pain, both positively and negatively .
A person with nervous irritation can easily contract muscles as an unconscious response. When we suffer muscular contractures in a prolonged manner in the body, it is easier for there to be difficulties in the area for blood and all the nutrients to arrive, which helps the pain to appear or to be maintained.
A person with nervous irritation may contract muscles as an unconscious response.
Psychological causes of low back pain
If we follow the Biopsychosocial Health model or paradigm, the psychological causes of low back pain can be grouped into:
- High level of stress
- High level of anxiety
- Emotional problems
- Recurrentnegative thoughts
- High level of physical self-demand
- Psychopathologies: depression, psychosomatic disorders, etc.
If we look for the main psychological cause of back pain, it is clearly stress and negative emotional states. These provoke visceral alterations and reflex pain, but also alter posture also alter posturewhen we suffer a lot of stress, the shoulders bend forward, and the body twists subtly like a spiral, with the trunk to the right and the pelvis and legs to the left. Interestingly, sciatica and low back pain relatedto stress and negative emotional factors often present pain on the left side.
It is important to note that the younger one suffers from stress, the more serious the postural alteration, being more marked if it occurs in childhood and adolescence, and less if it occurs during adulthood. If you want more information about the relationship between stress and postural alteration, click here.
When we suffer a lot of stress, the shoulders bend forward, and the body twists subtly like a spiral, with the trunk to the right and the pelvis and legs to the left.
how can stress make low back pain worse?
There are several aspects that can make a low back pain hurt more, or that can even slow down the improvement in the face of the treatment applied. The main ones involved are:
- Erroneous beliefs. This is the main cause of not progressing with the treatment of low back pain. An example of an erroneous belief is believing that low back pain is the product of a greater pathology. Or, for example, having more confidence in the treatments given by the physical therapist than in the exercises to be performed.
- Work-related factors: here we can group together short-term sick leave, lack of job satisfaction, lack of job security, etc.
- Emotional problems: such as stress, anxiety and depression among others. As mentioned above, these factors, together with anger, are closely related to the pain system.
- The counterproductive attitude towards pain: assuming that it will persist and limit the quality of life permanently.
- The fear of pain and the consequent reduction of activity: stop doing tasks that cause the slightest increase in pain or even those that do not cause it but the subject believes he/she can do it. We may even avoid activities that we used to find pleasurable such as running, exercising, having relations with our partner, etc.
- Self-perception of poor health.
If these symptoms are observed, an interdisciplinary consultation with a mental health professional would be advisable in order to better assess the situation. In this way, the appropriate approach can be taken to advance in the treatment of low back pain. If you would like more information on effective physiotherapy treatments for non-specific low back pain, click here.
what can we do psychologically to avoid low back pain or reduce its pain?
The most important thing to reduce low back pain is to control stress. Nowadays we lead a very frenetic lifestyle, with endless work schedules, the current economic and political situation…
It is important to take at least 2 to 10 minutes a day to stop. The most advisable would be to start with meditation and relaxation exercises. Even so, simply stopping between two and ten minutes a day, and breathing deeply, is enough (if you want to learn how to do breathing exercises, respiratory physiotherapy can be a good option). The important thing is to abstract from everything else, be in a quiet place and focus on breathing slowly for the minutes you choose. If you are somewhere like public transport, you can use headphones with relaxing music.
It is also very important to start taking charge of your life and stop waiting for others to come and save you. Doing the exercises recommended by the physiotherapist reduces pain and makes recovery faster. In addition, it increases self-esteem and confidence. In this way, the fear of resuming your normal life decreases, and your perception of your health improves.
It is also important to ask for help. If you have incapacitating low back pain, it is important not to force the machinery too much. If your work is physically demanding, or if you have to take care of the house and children on your own, ask for help. I am sure that the people around you will understand and will lend you a hand; everyone’s back has hurt at some time or another. Likewise, if you notice that your mood is lower than usual, that you are more anxious, that your physical treatment is not progressing? Go to a mental health professional.
If you suffer from low back pain and you are pregnant, this post may be of interest to you.
