Monday, January 7, 2013

Emotional Aspects of Low Back Pain

Emotional Aspects of Low Back Pain
WebMD Feature
By Stephanie Watson
Reviewed By Louise Chang, MD
You can eat a healthy diet, exercise religiously, and follow every single one of your doctor's recommendations -- but no matter how healthy or well-conditioned your body may be, at some point, your lower back is almost destined to cause you problems.

For most people, low back pain is just a minor annoyance that emerges once in awhile, sticks around for a couple of days, then goes away. For other people, there's no break from the pain.

When pain becomes chronic, it goes far beyond a physical sensation. It can impact your emotions, too. "The back pain can become a black hole for all of life's bumps in the road. Everything is blamed on the back pain. If the back pain were better, everything would be better," says Jerome Schofferman, MD, head of the Rehabilitation, Interventional, and Medical Spine Care (RIMS) Section of the North American Spine Society, and director of Research and Education for SpineCare Medical Group in San Francisco and Daly City, Calif.

How well you cope with your low back pain, and whether you get the right treatment for the physical and emotional impacts of it, will determine whether you control your pain -- or it controls you.

The Pain-Emotion Connection

Low back pain can be more than just physical. It can have a profound effect on your mood, and just about every other part of your life. "Chronic pain is something that interferes with every aspect of daily living. You can't concentrate -- you can't remember things as well. It affects your appetite, it affects your sleep," says Robert N. Jamison, PhD, associate professor in the Departments of Anesthesia and Psychiatry at Brigham and Women's Hospital, Boston.

People who are in constant pain may worry that they won't be able to work or go about their daily activities. With all of that stress, "It makes sense that people get depressed, anxious, and irritable," Jamison says.

Pain is more than just unpleasant sensations traveling through your nervous system. It also involves your perception, feelings, and thoughts. The worse you think your pain will be -- the worse it feels.

Some people with low back pain magnify their pain until it explodes into something far more profound than it really is -- a tendency known as catastrophizing. Say your doctor diagnoses you with degenerative disc disease. When you catastrophize, a whole range of scenarios runs through your mind. You imagine your back becoming so debilitated and painful that you have to quit your job and stay at home. You even envision a future in which you're confined to a wheelchair.

The physical and emotional toll of living in constant pain leads nearly a third of people with chronic pain to become clinically depressed. About 75% of people who are being treated for depression report physical symptoms, including pain. If pain can lead to emotional distress, the reverse is also true. The more trouble you have dealing with stress, the more likely you are to experience pain. In one small study, patients who were under mental distress or who had chronic pain (not in the lower back) were three times more likely to develop low back pain than those who had better coping skills.

Stress and pain can turn into an inescapable cycle. You're in pain, so you feel stressed and anxious. Stress can cause your muscles to tense up, which ratchets up the pain even more.

Another cycle can emerge -- this one centered on fear and avoidance. "People will avoid activities that they fear might either make their pain worse or [cause them to] reinjure themselves," Schofferman says. Avoiding physical activity will eventually weaken your body to the point that even if you want to finally go out and do something, you won't have the strength to do it.