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Psychological Factors of Chronic Back Pain

The Mind-body issue Most people think that the mind and the body are separate and function independently. Instead, these two usually work together in shaping our experiences. Sometimes psychological factors can reduce or eliminate the effects of physical problems. For example, one line of research asked normal volunteers (that is, people who have never complained of chronic back pain) to undergo imaging procedures such as CT scans or MRI scans. Surprisingly, about 40% of these subjects had ruptured disks, pinched nerves, cracked vertebrae, or some other form of physical problem that should have produced significant back pain, but didn't. On the other end of the spectrum, there are some rare cases of conversion disorder: a psychiatric condition where the person feels chronic back pain, but there is no identifiable physical problem at all. In most cases, though, chronic back pain is a psychosomatic (literally, "mind-body") condition, where a real physical problem exists, but psychological factors play a large role in determining the person's experience of that problem. In some cases, mental processes such as dependence, depression, or frustration may make the pain worse; in other cases, a positive attitude and a sense of independence may lessen the pain. Assessing psychological factors in chronic pain Screening surgical candidates The most commonly used methods for determining psychological factors in chronic pain are an in-depth interview and standardized measures such as inventories and questionnaires. Sometimes psychological assessment is recommended to determine who might be good or poor candidates for back surgery. Here are some factors that have been associated with poor surgical outcome:

Previous Surgeries: patients who have had 2 or more prior failed surgeries Secondary Gain: patients who have a financial or interpersonal interest in being disabled Drug Seeking: patients with a history of substance abuse, especially pain killers or alcohol Mental Illness: patients with a long history of anxiety or depression that preceded the pain Poor Psychological Mindedness: patients who see their problems in physical terms The Pain-Prone Personality: a personality style that is prone to developing chronic pain

The pain-prone personality Mental health professionals have identified a certain cluster of personality traits that is

more common in people who develop chronic pain, including chronic back pain. Some of these characteristics are: A deeply felt sense of duty and responsibility to others A strong work ethic of dedication and reliability Demanding a great deal from self and others Rigid, inflexible standards or morals Seeing physical disability as a "ticket out" Steps toward improving back pain Living with pain The first step in dealing with chronic back pain is to accept the fact that the pain will be persistent and to find ways to cope with it. In other words, it's an attitude adjustment where one stops trying to eliminate all pain but instead decides to make the best of it. It may sound surprising, but this acceptance of pain goes a long way toward dealing with it, and eventually reducing, chronic pain. Here are some steps toward dealing with chronic back pain. Medical compliance In most cases, the problem is that patients don't take enough medication; they quit too early or take it irregularly. In contrast, chronic pain patients often abuse their medications by taking too much or taking it too frequently. If patients are to live with their pain long term, it is important that they take their medication as prescribed. Physical conditioning Often chronic pain patients think that physical conditioning no longer applies to them. In reality, though, physical conditioning is even more important for these patients. Excess weight, smoking tobacco, alcohol abuse, etc. all exacerbate chronic pain problems, and chronic pain patients must be especially careful to remain in the best shape they can be. In addition to your doctor, medical professionals such as physical therapists and registered dieticians are available to help develop proper exercise and eating. Stress reduction Simply put, stress makes pain worse. Not all stress is avoidable, but reducing or eliminating sources of persistent stress where possible will help in reducing the overall experience of pain. Seeking professional counseling for personal or relationship problems is very helpful. So is making changes in your work situation. Interpersonal support It is natural for others to become frustrated with a person's chronic pain. Endless complaints and irritations naturally drive away others, especially those who feel their efforts at support are not appreciated. Therefore, the chronic pain patient must make special efforts to foster and maintain their social supports by expressing gratitude and flexibility whenever possible. Caregivers must be wary not to become frustrated at their patients' lack of progress and to respect pain patients as important individuals.

Staying active Although it's tempting to give up important activities because of chronic pain, it's important to keep busy. One of the best strategies for living with chronic pain is distraction. It is important for self-esteem as well as pain management to maintain some work role if possible, establish a clear role in the family, take on regular interpersonal duties (e.g., helping children with homework), and maintain active hobby or personal interests. Pain reduction techniques Psychological techniques to reduce pain, such as yoga, biofeedback, and self-hypnosis, are important aids to reducing chronic pain. But they are not magical solutions that can completely eliminate pain. Rather, their role is to assist the pain patient cope with pain.