The Circle of Persistent Back Pain

It is not uncommon for sufferers of persistent back pain to be trapped in a negative circle of fear. Often it is a variety of different elements that contribute to this trap. Including their own strongly held beliefs, psychological & behavioral responses, along with physical and lifestyle factors.

A Strong Belief about Back Pain

A common held belief is that back pain is the result of a structural problem – which unfortunately is influenced by healthcare practitioners. Structural problems are rare with back pain – even disc prolapses and dehydration are commonly found in pain-free populations. Such findings can therefore be considered normal. However it is this fear of a structural problem and pain that drives behaviour. Bending is often believed to be harmful and that avoidance is the best from of protection. Which couldn’t be further from the truth.

Behavioural experiments that challenge these negative beliefs and protective responses can have surprising effects.  As highlighted by a recent case study where pain-related fear was markedly improved. Interestingly, these improvement were maintained at 6 & 18 months follow up. Although this may only be a case study it is part of the mounting evidence supporting the view that persistent musculo-skeletal pain is multi-factorial in nature.

Making a Change

The good news is that for many chronic pain sufferers by targeting the main drivers of their symptoms physio’s can have a positive influence on their pain and function. Helping them to confront and overcome their fears, become active and return to their normal valued activities.

However to achieve this change a little guidance is usually necessary. Physiotherapists can play an important roll in the journey of recovery. Helping those individuals to recognise the different factors and how to make those essential changes to get them better!

See also:

• Benefits of sleep – sleep and pain (Part II)
• The benefits of sleep – emerging evidence (Part I)
• Stress and pain sensitivity
• Low back pain: why we need to pay attention?
• Does degenerative disc disease exist?

• Pain Related Behaviours