How is stress impacting your lower back pain?

Lower back pain is common. We have all experienced it or at least know someone who has. In fact, research shows that around 6 in 10 people will get it at some point during their life. The peak in the number of cases occurs at 50–55 years with women experiencing a higher prevalence than men. In most cases, back pain gets better within a few weeks with some simple self-help measures.

You may not need treatment, per say, but sometimes your pain may last longer and affect your daily life and work. You may feel anxious, low or emotional, which can make your pain feel worse.

Treatments for back pain can involve both physical and  psychological techniques. Research from Wyns et al (2023) has helped us to better understand the pathophysiological mechanisms behind how stress influences pain and what we can do about it. In this blog, I’m going to explain Pro Health Physio’s approach to treating lower back pain and how staying active and maintaining a positive attitude towards pain can help you to manage your symptoms and get better sooner.

How do emotions affect back pain?

Stress has been consistently linked to negative impacts on physical and mental health. More specifically, those with chronic pain experience stress intolerance. This is an exacerbation or occurrence of symptoms, in this case lower back pain, in response to stress.

Some stress can be beneficial- such as planned and structured exposure to certain physical stressors such as exercise. Over time, the body builds up tolerance to these physical stressors and can cope better when the whole physiological system is under pressure.

How you feel and respond to pain is a really complex process and largely remains unsolved. There’s the physiological process – what’s happened in your body to cause the pain. And then there’s the psychological process – how your brain reacts to the pain.

Your pain is very real and everyones experience of pain is individual. We encourage you to be doubtful of someone who says it’s all in your head. However your perception of how bad it feels are strongly influenced by your feelings, attitudes and beliefs.

Catastrophization is the biggest predictor of developing long term persistent issues. So does that mean remaining optimistic and hopeful is a protector against long term chronic pain?

Take Christmas time, for example. Now, of course Christmas is often a wonderful time of year with days off work to relax and spend quality time with loved ones. If I know families though (and I do), it’s not always as straightforward as this. It can be a highly stressful time for a multitude of reasons; missing family members after bereavement’s, historical family arguments, getting the right gift for the kids and even the pressure of not overcooking the turkey! As a result, you may have noticed your pain feeling worse recently, especially if stress has been particularly high.

Your pain will also have a greater impact on your daily life if you’re feeling stressed or feeling low. If you avoid the activities that you think are related to your pain, this can make your recovery take longer. Furthermore, you’re not going to be your usual happy self if you’re not doing the things you love doing!

There is plenty of research on certain things which can slow your recovery. Here are some examples:

– The belief that pain and/or activity is harmful. These may be your own beliefs or be being reinforced by people who may be trying to protect you.

– Negative actions can reinforce the belief that you’re unable to exercise – for example, staying in bed for a long time or not going to the gym or isolating yourself from family, friends or work colleagues.

• Relying too heavily on passive treatments. For example, massage is a great way to feel better for a short term period. Now, providing someone with up to 72 hours of relief following a massage or manual therapy may be a HUGE factor to help that person realise their pain can settle & open a door for them doing some mobility exercises. We should also be exercising to slowly increase your physical activity levels and emotional resilience.

-Micro stressors: We can not eliminate all stress from our lives, but we can look at certain triggers, try to minimise these. We can learn to accept factors outside of our control, and take an active approach to things we can control. Finally we can rest assured, we know that despite the pain being present, it will not last forever or to the severity it currently is.

Managing your emotions and feelings to help your back pain

At the start of this blog, we briefly discussed how treatments for pain, lower back pain specifically, can and should involve physical and psychological aspects. So let’s really delve in to what we mean by psychological treatments and how we integrate it into sessions at Pro Health Physio.

By managing our feeling and beliefs around pain, we can start to work through any barriers and help you back to your normal. This is known as psychological therapy. When having this conversation in clinic, I’m always cautious and often adopt an approach where the client leads. If you’re terrified of exercise because you’ve been told that your X-ray showed “degenerative disc disease” or a “crumbling spine”, me taking you straight into the gym to start deadlifting probably isn’t going to go down well. Look at it another way; I’m scared senseless by spiders, especially house spiders. If I had gone to someone to help me over this fear and they stuck me in a room full of them, I’m leaving, never coming back and certainly not moving forward past that particular fear. On top of that, I’m going to be wary of anyone else I go to see about my arachnophobia as well!

All care should be patient-centred. As a result, there are many different approaches to treatment and which route we take will be guided by you, the client. These may focus on the following areas:

– Your behaviour and actions – we look what you’re currently doing to manage your pain and if there’s anything we can do differently.

– Your thoughts and feelings – we’ll aim to identify and change the negative feelings you may have about your pain, what causes it and how to deal with it.

– Your body’s response to pain – learning strategies to manage your body’s reaction to pain, which may also be exacerbating your symptoms

There is lots of excellent research now showing that psychological therapy is more likely to help with your pain than just using standard medical treatments and physiotherapy alone. Equally, only using psychological therapy and nothing else is also unlikely to be effective, so we won’t be trying to “talk your pain better” either!

Where to start?

Often, your back pain will settle in it’s own time. But if it doesn’t, its better to nip it in the bud rather than let it develop into something more long term. If your back pain continues, speak to someone at Pro Health Physio where we can help educate, guide and rehab you back to your best.

Firstly we will make sure there is nothing more sinister going on by asking specific questions about your symptoms. If there is anything we are concerned about, we will deal with it straight away. If you speak with your GP, they may recommend you try talking therapies and physiotherapy. Who you’ll see or where you’ll go for this treatment will depend on the services available in your area. Here at Pro Health Physio we have extensive training in cognitive behavioural therapy (CBT) and cognitive functional therapy (CFT), so can offer everything under one roof.

CBT/CFT will involve your therapist helping you to think differently about your pain and to develop strategies for carrying out your daily activities.

Acceptance and commitment therapy (ACT) is an extension of CBT including mindfulness to help accept the situation rather than simply living with trying to avoid your pain. There is some evidence that it can make your pain feel less severe.

Actions steps to takeaway:

STEP 1: IDENTIFY BELIEFS

Identifying any negative beliefs and feelings you have about your pain. You can then work out how to change them.

STEP 2: IDENTIFY STRATEGIES

Putting strategies in place to help you manage your back pain in a healthy way. This may involve removing unhelpful factors such as relying too much or too little on painkillers. By focusing on increasing exercise instead can help you go back to your normal activities.

STEP 3: IDENTIFY ALTERNATIVES

Relaxation therapies, such a breathing techniques. These can help to reduce tension in your muscles and help with your pain. Some people find journalling about their pain helpful.

STEP 4: IDENTIFY PROGRESSIONS

We’re back on the right track and successfully working towards getting you OUT of pain. But the job isn’t done sadly. Let’s identify where we can start working you harder so that you’re STAYING out of pain. Psychological therapy may not make your pain go away, but it can certainly help to reduce it and help you live a healthier, more fulfilling life.

So, are you ready to take action now?  Book in to see one of the team at Pro Health Physio where we have a range of professionals with extensive experience in lower back pain.

James: Physio trained in Cognitive Behavioural therapy

Darren: Physio trained in Cognitive Functional Therapy

Ron: Chiropractor- Manual therapy, massage, hands on approaches.

Alex: End stage Gym based, physio led S&C

SJ: Absolute wizard of a physio who has seen every injury you could imagine!

References:

Wyns, A., Hendrix, J., Lahousse, A., De Bruyne, E., Nijs, J., Godderis, L. and Polli, A., 2023. The Biology of Stress Intolerance in Patients with Chronic Pain—State of the Art and Future Directions. Journal of clinical medicine, 12(6), p.2245.  https://pubmed.ncbi.nlm.nih.gov/36983246/

Lorimer Moseley, Why things hurt? TED talk, Adelaide. https://www.youtube.com/watch?v=gwd-wLdIHjs

The Pain Toolkit: Peter Moore, Follow Link here.