Most people of working age spend most of their waking lives at work. Indeed, work constitutes a major part of life and can have a major impact on health, for better or worse. As you can imagine, health and wellbeing at work is a large and very active area of research. Overwhelming evidence tells us that psychological factors most consistently predict who will develop back pain – stress simply causes the body to behave more symptomatically. To date, several studies have served to tease out the workplace-specific psychological factors at play.
In 2012, a study which tracked 2,808 workers from 28 different organisations in Norway for two years found that lack of decision control and lack of leadership quality were the most consistent predictors of who would develop back pain 1.
In 2010, a study which tracked 1,704 workers in Israel for three years found that burnout doubled the risk of developing a musculoskeletal disorder, such as back pain 2.
Coping and purpose
Our ability to cope and our sense of purpose have a significant impact on our health. Perhaps one of the most compelling combined measures of coping and purpose is the ‘Sense of Coherence’ (SOC) assessment. Low SOC has been found to predict back pain 3, neck and shoulder pain 4, and back pain surgery outcome 5. The SOC assessment measures three distinct components, detailed below.
- Comprehensibility: The belief that things happen in an orderly and predictable fashion and a sense that you can understand events in your life and reasonably predict what will happen in the future.
- Manageability: The belief that you have the skills or ability, the support, the help, or the resources necessary to take care of things, and that things are manageable and within your control.
- Meaningfulness: The belief that things in life are interesting and a source of satisfaction, that things are really worthwhile and that there is good reason or purpose to care about what happens.
In addition to the 13-item SOC assessment, our survey included a question designed to explore maladaptive coping behaviours – specifically looking at reliance on drugs and medications during times of stress.
Current physical symptoms
As discussed, stress is the most consistent predictor of back pain in clinical research. In fact, the evidence supports the idea that back pain is one of the most common forms of somatisation. What’s somatisation? Well, ‘somatisation’ is the technical name for this very common process through which psychological stress causes physical symptoms. Put simply, the body functions differently in the context of stress. Without pre-existing psychological factors, the usual physical triggers such as posture and lifting are largely unrelated back pain.
Tension headaches represent the most common and most familiar example of somatisation. Somatisation can also take the form of many other symptoms that people commonly experience, including chest pain, stomach pain, shortness of breath, and insomnia. In a sense, somatisation is ‘normal’ in modern societies where more than 90% of people will experience tension headache and more than 80% will experience back pain at some point in their lives.
However, whilst some people may be occasionally bothered by mild headache, others suffer considerably from multiple concurrent and severe stress-induced symptoms. When this happens, they may be classified as having a ‘somatisation disorder’, meaning that they have developed the general tendency to process stress as physical symptoms. In light of this, our survey included a 15-symptom checklist (PHQ-15) which is used within the NHS and clinical research to help detect somatisation disorders.