Most people agree that emotional stress or psychological factors can make any pain, including back pain pain worse.
However, the concept of “stress-related” or psychosomatic back pain, which is primarily caused by psychological and emotional factors, is usually harder to grasp.
It is important to make affected patients understand that even though psychological factors may be causing the physical symptoms, the symptoms are not imaginary
Instead, the unresolved emotional tension is pushed out of awareness into the unconscious mind, which then causes changes in the body’s nervous system, leading to muscle tension, spasm and the back pain experienced by the patient. This chronic pain can lead to insomnia, fatigue, disability and then depression in a viscous feedback cycle:
This syndrome can be hard to recognize for 2 reasons:
First, the pain may actually start with an identifiable incident that caused lower back sprain or strain, but then continue as the result of emotional factors long after any physical injury should have healed.
Second, MR imaging studies are so sensitive, that when used inappropriately they may demonstrate incidental “findings” such as a “disc bulge” or “degenerative disc disease”, and the pain becomes attributed to this even when stress is the actual culprit.
The end result is that the affected patient gets sent for endless cycles of physical therapy, then epidural injections and even surgery. Despite these measures, many patients continue in chronic pain.
If the back pain can be correctly identified as stress related in the first place, then the patient can be encouraged to “think psychological, not physical”, and get some psychotherapy to address the unconscious issues.
Obviously, this approach is very different than the way most physicians manage patients with back pain.
Perhaps it’s time for a game change?