No one likes to experience back pain. Having such a crucial part of your body in any metric of discomfort—be it a mild ache or a day-ending agony—will no doubt put a major damper on your mood. However, something that many people don’t know is that this simple fact of life can turn into a never-ending feedback loop if you don’t receive treatment for back pain, slowly deepening your misery as your pain becomes more and more unbearable.
So, why is it that sometimes, “toughing it out” just doesn’t work? What is it about back pain that makes it seem to get worse as time drags on? Most importantly, is there a link between emotional stress and back pain?
Back Pain and Stress
Before we can talk about how stress can cause more back pain, we need to first explore how exactly back pain can cause stress. It may seem obvious: your back hurts and that’s a huge bummer; therefore, you are stressed. However, this isn’t the whole story. In fact, there’s more of a social nuance to back pain than there is to most other bodily aches. Consider for a moment: what do you associate leg pain with? You may be thinking about an athlete with a muscle strain or a retail worker who’s been standing at a register for a little too long. However, you probably aren’t immediately thinking of someone who is inherently weak or of advanced age. Indeed, back pain has a slew of associations to go with it, and sometimes it’s more than just a stubborn pinched nerve that’s causing you back pain. These associations can, in turn, drag down the sufferer’s health even further than it would’ve been originally.
A Lack of Understanding
Patients with chronic back pain expressed a high tendency to feel misunderstood but professionals and peers alike. There seems to be a pervasive mentality of people with chronic back pain being the butt of many “old man” jokes, and this, unfortunately, manifests in the form of CBP sufferers being very wary of healthcare. It’s not like they don’t want to be understood either—quite the opposite, in fact. There is a strong desire to be seen and helped that just isn’t met, and this can cause major strife in a person’s life.
To add insult to injury, even when they do experience positive treatment from healthcare workers, they still feel highly vulnerable and unable to affect their own situations. This can be due to a variety of factors ranging from general hopelessness generated by being in pain day in and day out to past mistreatment from friends, family, and even medical professionals.
A Lack of Care and Trust
As mentioned before, healthcare professionals aren’t always saints. In the case of a condition as stereotyped as back pain, doctors and nurses can become dismissive, jaded, and even entirely ignorant of a patient’s needs. In the case of one particular patient suffering from severe chronic back pain, she was forced to lay in positions that would cause her intense pain until they finally heard her out and let her stand as they weren’t getting any good x-rays due to her writhing. Other times, patients reported feeling as though their specialists were being “railroaded” by their professions, not taking alternate perspectives or treatment methods into account and instead continuing to use treatment plans that outright don’t work for some.
What’s more: women reported receiving particularly high amounts of disdain or dismissal.
Namely, they weren’t taken as seriously when they were younger, and if they thought to dress nicely or put on makeup, they would be outright brushed off. This is not too surprising, as unfortunately, misogyny runs deep in the medical field.
None of this is to discourage anyone from seeking help for their pain, and especially not women. However, it’s important to remember your rights as a patient and remember that you can opt to switch doctors if you feel like your current one is mistreating you.
Strength as an Obstacle
On the opposite end of the spectrum, some patients are simply too stubborn to accept the full care that they need. As back pain is often associated with the elderly and frail, many patients reside in a deep state of denial over the reality of their bodies. Sometimes, this manifests in patients stubbornly trying to fit into care plans that simply do not work for them. Other times, it appears as a patient rejecting a treatment plan entirely, opting to deal with their pain in a way that they feel is right rather than what may actually be best for them. Even more still reject caring hands entirely, refusing to be treated as disabled even though they may very well be disabled.
This is a phenomenon most often seen in men, as they are often expected to be the strong, stoic guardians of the family. This social refusal to allow men to express basic sensations like pain and weakness can lead to their problems worsening to the point of becoming life-threatening in some cases. Remember: the doctor’s office isn’t a place for keeping secrets.
Stress and Back Pain
So, now that we have a more nuanced understanding of the stressors that patients facing chronic back pain must endure, this still doesn’t answer the key question: how do stress and back pain create a feedback loop?
To answer that, we must consider psychogenic ailments. When a condition is “psychogenic,” what this means is that it displays physical symptoms that are entirely caused by a mental stressor. These can range from general pain to seizures and, in rare cases, can even manifest as the total loss of one or more senses. Psychogenic blindness, for instance, is a rare but documented response that many people have expressed when confronted with a traumatic situation. Their eyes will appear to be completely undamaged, but their brains will not allow them to see.
Back pain is another symptom that can manifest in a psychogenic manner. It has gone by a few names in the past—spinal irritation and tension myositis syndrome being two notable monikers—but the standard sentiment remains the same: it is back pain caused by stress.
The Pain Cycle
Though this would make a very good name for a metal band, the reality of the pain cycle is far less glamorous. It is a model that shows what likely is going on in a patient’s mind and body as psychogenic back pain sets in.
First, the patient experiences stress. Then, they begin to experience stress-related back pain. They may seek help for the pain itself but not receive any clear answers. Not knowing that the stress is the problem, they stress themselves out further over the fact that they have back pain. This, in turn, makes the back pain worse. Rinse and repeat until the stressor is finally addressed. This pain cycle is also characterized by the patient losing interest and withdrawing from daily life and activities, which can be caused by the discomfort itself or the fear of exacerbating their condition through high activity. This can cause the patient to lead a more sedentary life, causing them to weaken the muscles in their back that support their spine. With those muscles weakened, the back pain intensifies. From this point, it also has a higher chance of developing into a more tangible condition, such as a herniated disc or a strained muscle.
The psychological problems may also worsen. This, in turn, may lead to depression, anxiety, and agoraphobia. Again, it should be noted that it’s just stress causing the back pain to begin with.
Diagnosis and Treatment
Fortunately, the treatment is fairly straightforward in the early stages: remove the stressor, and the pain should begin to dissipate. Diagnosis, on the other hand, can be trickier. Patients should exercise caution when attempting to self-diagnose stress-related back pain, as the pain could be caused by a life-threatening illness (such as a spinal tumor or infection), but it’s common for doctors to miss the signs as well and attribute the pain to muscle soreness. A detailed medical history and physical exam are frequently used to diagnose stress-related back pain. In the vast majority of cases, a thorough medical examination can rule out the more significant structural reasons for back pain.
If you need treatment for your back pain, AICA Lithia Springs may be able to help. Whether it’s stress-related or not, our team of professionals will be able to help you find a treatment plan to suit your individual needs, so there’s no need to stress about it.