Louise Chang, MD
You can eat a healthy diet, exercise religiously, and follow every single one of your doctor's recommendations -- but no matter how healthy or well-conditioned your body may be, at some point, your lower back is almost destined to cause you problems.
For most people, low back pain is just a minor annoyance that emerges once in awhile, sticks around for a couple of days, then goes away. For other people, there's no break from the pain.
When pain becomes chronic, it goes far beyond a physical sensation. It can impact your emotions, too. "The back pain can become a black hole for all of life's bumps in the road. Everything is blamed on the back pain. If the back pain were better, everything would be better," says Jerome Schofferman, MD, head of the Rehabilitation, Interventional, and Medical Spine Care (RIMS) Section of the North American Spine Society, and director of Research and Education for SpineCare Medical Group in San Francisco and Daly City, Calif.
How well you cope with your low back pain, and whether you get the right treatment for the physical and emotional impacts of it, will determine whether you control your pain -- or it controls you.
Low back pain can be more than just physical. It can have a profound effect on your mood, and just about every other part of your life. "Chronic pain is something that interferes with every aspect of daily living. You can't concentrate -- you can't remember things as well. It affects your appetite, it affects your sleep," says Robert N. Jamison, PhD, associate professor in the Departments of Anesthesia and Psychiatry at Brigham and Women's Hospital, Boston.
People who are in constant pain may worry that they won't be able to work or go about their daily activities. With all of that stress, "It makes sense that people get depressed, anxious, and irritable," Jamison says.
Pain is more than just unpleasant sensations traveling through your nervous system. It also involves your perception, feelings, and thoughts. The worse you think your pain will be -- the worse it feels.
Some people with low back pain magnify their pain until it explodes into something far more profound than it really is -- a tendency known as catastrophizing. Say your doctor diagnoses you with degenerative disc disease. When you catastrophize, a whole range of scenarios runs through your mind. You imagine your back becoming so debilitated and painful that you have to quit your job and stay at home. You even envision a future in which you're confined to a wheelchair.
The physical and emotional toll of living in constant pain leads nearly a third of people with chronic pain to become clinically depressed. About 75% of people who are being treated for depression report physical symptoms, including pain. If pain can lead to emotional distress, the reverse is also true. The more trouble you have dealing with stress, the more likely you are to experience pain. In one small study, patients who were under mental distress or who had chronic pain (not in the lower back) were three times more likely to develop low back pain than those who had better coping skills.
Stress and pain can turn into an inescapable cycle. You're in pain, so you feel stressed and anxious. Stress can cause your muscles to tense up, which ratchets up the pain even more.
Another cycle can emerge -- this one centered on fear and avoidance. "People will avoid activities that they fear might either make their pain worse or [cause them to] reinjure themselves," Schofferman says. Avoiding physical activity will eventually weaken your body to the point that even if you want to finally go out and do something, you won't have the strength to do it.
Taking medication or having surgery can address the physical cause of your pain, but if you're anxious or depressed, it won't solve your entire problem. "You need to treat the structural problem and the psychological problem. Both need to be addressed at the same time," Schofferman says.
For people with mild to moderate low back pain, a supervised exercise program may be enough to treat physical and psychological symptoms. "Many times when the person exercises under supervision…their depression improves, their anxiety can improve, and their avoidance improves," says Schofferman. The goal of these programs is to strengthen the muscles of your back and the areas that support your back (such as the abs), and teach you how to do everyday activities -- like lifting and bending -- without hurting your back.
If you have more chronic, severe low back pain, it helps to see not just one doctor, but a whole team of experts that can include your regular doctor, an orthopaedic doctor or physiatrist, as well as a chronic pain specialist, physical therapist, and psychologist. All of these specialists should have experience in treating chronic pain.
Plan to be an active participant in your treatment. Keep a journal of your pain, so you can start to see patterns -- when the pain tends to occur and what triggers it. Then talk to your doctor to learn about the different therapies available. Behavioral therapy can help you cope with your pain and deal with any limitations or depression you're experiencing as a result.
Relaxation techniques like deep breathing, progressive muscle relaxation, and biofeedback can teach you how to ease the muscle tension that's contributing to your low back pain. Your doctor may also prescribe medications to relieve pain, help you sleep, or ease your depression and anxiety.
Work with your doctor to come up with a comfortable level of physical activity. Jamison describes two types of back pain patients. "There are the folks who throw in the towel and refuse to get off the couch or bed…and those who refuse to sit down and pace themselves." Neither approach is going to help your back feel better. Don't do more than you can comfortably handle, but don't become a couch potato either. Exercise is actually good for managing low back pain and stress for many people. However, depending on your health and medical reason for back pain, certain exercises may be harmful. Make sure to discuss an exercise regimen with your doctor first if you have chronic back pain.
It's important to keep not only your body -- but also your mind active. "We know that distraction is really important," Jamison says. "If it's nothing but you and the pain and the four walls, your pain can loom pretty large. Keep your mind occupied -- that does help people cope with the condition." Get together with friends, go to the movies or a show, or take a walk outside to keep your mind off your pain.
SOURCES:National Institute of Neurological Disorders and Stroke: "Low Back Pain Fact Sheet."Robert N. Jamison, PhD, associate professor in the Departments of Anesthesia and Psychiatry at Brigham and Women's Hospital, Harvard Medical School, Boston.National Pain Foundation: "Pain and Your Mental Health."Carragee, E. Spine, May 15, 2004; vol 29: pp 1112-1117.Moldovan, AR. Journal of Cognitive and Behavioral Therapies, March 2009; vol 9: pp 83-93.Williams, K. Spine, September 2009; vol 34: pp 2066-2076.Jerome Schofferman, MD, head of the Rehabilitation, Interventional, and Medical Spine Care (RIMS) for the North American Spine Society; director of Research and Education for SpineCare Medical Group in San Francisco and Daly City, California.
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