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Most episodes of back pain get better quickly and without needing treatment. But unfortunately, for more than two million UK adults each year, the pain doesn’t go away. Now, growing evidence suggests that the way you think and feel can accurately predict whether or not you’ll recover from back pain. But how can psychology predict pain? Put simply, feeling stressed or anxious increases our stress hormone levels, making the body more symptomatic over time. And old-fashioned thinking about back pain can lead us to make bad health decisions that can block recovery.

The evidence is so strong that GPs and physiotherapists look for these barriers to recovery (‘Yellow Flags’) in order to best help to those at high risk of developing long-term back pain. Early identification and management of psychological risk factors has been found to be effective at preventing long-term back pain. If you already have back pain and strongly agree with four out of these five statements, you are at high risk of developing chronic back pain.

  1. “It’s not really safe for a person with a condition like mine to be physically active”

Back pain itself is not harmful. The belief that back pain is harmful, or that it indicates damage or further injury, often causes people to avoid physical activities for fear they’ll make things worse. In fact, this kind of ‘fear avoidance’ behaviour (kinesiophobia) predicts long-term pain and disability.  A tailored programme of Cognitive Behavioural Therapy (CBT) which reduces fear and changes pain beliefs has been shown to increase the back pain recovery rate.

  1. “Worrying thoughts have been going through my head a lot of the time”

Stress, tension and anxiety make you more likely to develop back pain and less likely to recover, so they’re really central to effective back pain prevention and treatment. The trouble is that stress is often invisible or becomes accepted as a normal part of our hectic lifestyles. Patients are naturally uncomfortable with the idea that stress is making their health worse, but often don’t realise that it makes all the difference. Talking therapies or self-help practices can used whenever stress or anxiety are identified.

  1. “I feel that my back pain is terrible and it’s never going to get any better”

Assuming the worst (‘catastrophising’) and repetitive thinking (‘ruminating’) predicts long‑term pain and disability. CBT can be used to tackle these negative thought patterns. The basic approach involves techniques to: become more aware about your mental activity; learn to halt runaway thoughts; and cultivate new positive thought patterns. These kinds of techniques have been shown to be effect, but do require motivation and engagement.

  1. “In general, I have not enjoyed the things that I used to enjoy”

When back pain takes over it can become impossible to enjoy life. Unfortunately, struggling to cope with pain and disability (lower ‘self-efficacy’), is known to affect stress hormones and other systems in the body, and ultimately predicts poor chances of recovery. Again, whilst the way the people think and feel is commonly assumed to be a fixed part of their personality, evidence shows that CBT is an effective approach to increasing self-efficacy.

  1. “Overall, my back pain has been very bothersome in the last two weeks”

The more you are bothered or troubled or burdened by pain, the longer it will take to recover. This does not mean you should ignore pain and suffer in silence, but research shows that how you feel about the pain predicts your chances of making a speedy recovery. BackCare’s own research has shown that it also predicts whether you’ll have other physical symptoms – compared to people who are “bothered a little” by their back pain, people who report being “bothered a lot” are around 50% more likely to also have stomach pain and chest pain. Again, burden is a function of coping, and approaches such as CBT are recommended.