I believe that we, as humans, have a tendency to always look for the one single cause for every problem we encounter. Often though, and especially when it comes to back pain, there is not one single cause but more like an ocean of causes that contribute to the problem to varying extents. Back pain is one of the most puzzling conditions, and it is still being researched. What we do know is that back pain is complex and cannot be deduced to one distinguishable condition. Some interesting facts are that:
- Only about 1% of all back pain occurrences have a really serious cause, such as a fracture.
- 90% of all people would have degenerated discs detectable in a MRI scan.
- 50% of the general population think pain means that the back is damaged.
Back pain is not only connected to physical issues but also to psychological and emotional.
So, most back pain doesn’t signify a serious injury, and injuries are common and usually not dangerous but still we tend to think that that it is precisely the opposite.
Your prospects of becoming pain free are affected by how you perceive pain.
The last time I experienced back pain I was working at a place I didn’t like, for a number of reasons. One reason was that I had to commute for one hour and forty-five minutes by train only to get there. This was at the same time as public health minister of Sweden declared sitting down to be the new smoking, i.e. really, really harmful and to be avoided at all cost. I had to sit for one hour and forty-five minutes and I hated it, I literally felt how my body degenerated during those commuting hours. And of course it was devastating for my back. From being located to the right side of the spine in the lower back the pain started to spread, affecting my upper back and my shoulders as well. Everything got so unpleasant I could barely sustain myself. Then on the weekends I usually took the train in the other direction to go for a hike in beautiful mother nature. Two hour train rides was not uncommon (oh lord, won’t you buy me a Mercedes benz?) and did I ever experience pain during those hours of sitting down? Well, I did, but it was much, much less, it was bearable and it didn’t affect my mood like it did when I travelled to work.
Peter O’Sullivan is a physiotherapist engaged in the field of back pain. He highlights the complexity of lower back pain and criticises traditional clinicians for still considering back pain to be directly related to structural damage, even though research prove, time after time, that damage doesn’t necessarily equate pain. Structural damage in the back may lead to pain, but a back with no structural damage may hurt as well. So even if its possible to detect one or a few causes for pain it’s not really interesting to do so, but instead to look at what we can do to feel better. Highlighting the psychological and emotional causes for pain does not mean that structural or physical aspects are completely irrelevant, however. For instance, while most people with bad posture will never experience pain, bad posture may for other people be one among several causes for pain. That is, a bad posture won’t automatically lead to pain, but if you have pain, working with your posture may be a relief.
An important concept in regard to the complexity of pain is the pain cycle. Just as it sounds, the pain cycle describes how pain or injury leads to behavioural changes, which in turn leads to reinforced pain or prevents healing. A perfectly normal reaction to pain is avoidance: the body moves to avoid pain, if moving normally hurts more then it does to move in a distorted way, then your movements will be distorted. The body starts to compensate so that over time muscles, ligaments and nerves adjust to a new movement pattern that makes some muscles weaker and other muscles more tense. This in turn leads to sustained or aggravated pain. Another version of the pain cycle concerns the emotional aspects of pain so that pain leads to various forms of emotional suffering, which in turn leads to the experience of pain being intensified.
This is where fear comes into play. Increased levels of fear of pain correlates with increased pain. Reducing fear can also reduce the pain experienced. Honestly, it can even be that the fear is worse than the actual pain, because fear happens at so many levels. It is the physical level of ”whats happening to my body, am I ever going to move in an unrestricted way again?”-feeling, it is the emotional feeling sorry for yourself or just feeling worthless, a sense of there being something wrong that feels deeper and more profound than just an aching body part. In the upcoming post I continue to dig into the topic of fear in relation to pain.