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Back Pain Special Report

Back Pain – Is It All in Your Head?

This Special Report is intended for readers interested in learning about the prevention, diagnosis, and management of back pain.

Is stress contributing to your back pain? Johns Hopkins explains how the “fight-or-flight” response can lead to severe back pain … and provides techniques to help you relax.

Could the day be coming when a person who complains of back pain be given a psychological assessment in addition to a physical one?

The list of potential triggers of back pain is a long one, including such factors as genetic predisposition, congenital malformations, and traumatic injuries. A growing number of studies affirm that the mind-body connection also plays a role in back pain, both in setting off an initial “back pain attack” and in contributing to ongoing chronic back pain.

In several recent studies, psychological distress proved to increase the risk both of developing back pain and of experiencing a slow recovery. For instance, in a Swedish study, anxiety and the practice of “catastrophizing” -- assuming the worst in any given situation -- were found to increase the risk of developing back pain. And in a study conducted in this country, people who reported higher levels of anger and psychological distress also reported higher levels of chronic back pain. These and other findings underscore the need for a multidimensional view of back pain and the recognition that back pain can involve much more than just the muscles and bones of our backs.

Understanding the connection between stress and your back
By now, most of us are familiar with the “fight-or-flight” response. When confronted by a threat -- whether physical or emotional, concrete or imagined -- the hypothalamus releases noradrenaline and adrenaline. These and other related hormones trigger a complex cascade of actions, leading to a state of physiological and psychological hyperalertness.

The difficulty comes when this state of hyper-alertness becomes our default setting. Stress is an inescapable fact of modern life. We now know that if we’re hyperaware of the multitude of stressors we face on a daily level, we are predisposed to develop a number of diseases, including depression and heart disease.

On the musculoskeletal level, the fight-or-flight response causes muscles to tense in preparation for action -- and if this response is not deactivated, muscles can go into painful spasms and severe back pain can result.

Breaking the cycle that leads to back pain
While stress-relaxation techniques can’t make a stressful situation disappear, they can help you consciously release any muscle tension you may have accumulated in anticipation of or response to the situation. Here are some techniques to consider to help relieve your back pain:

  • Breathing exercises. One breathing technique that can quiet the fight-or-flight response is known as 2:1 breathing. Try a pattern of inhaling to the count of three and exhaling to the count of six. Repeat several times.
  • Body scan. Begin by either lying or sitting down. Do several cycles of 2:1 breathing. Once you are fully relaxed, conduct a full mental sweep of your body, as though you were undergoing a deliberate and complete x-ray. Go slowly but steadily, noting any areas of tightness or tension. Once you’ve finished the scan, return to those tight or tense areas and let your attention linger there. Consciously “breathe into” those areas for several breathing cycles and imagine the muscles relaxing.
  • The body scan takes time -- but if it is done on a regular basis, it can help you become aware of the early warning signs of an impending back pain attack. In particular, it can help you become aware of your individual “signal spots,” those places that hurt when your back first begins acting up but before a full-blown attack is already under way. You can then take action, pacing yourself appropriately.

  • Meditation. This has been found to reduce stress and counteract the fight-or-flight response. One meditation technique is known as “taking the one chair.” Imagine yourself in a room in which there is only a single chair. Sit down on the chair and observe your thoughts and emotions pass in front of you. Remember that you are occupying the only chair in the room, so your thoughts have no place to rest. Watch them pass on out of the room.
  • Exercise. Exercise -- particularly meditative exercise such as yoga, walking, or swimming -- is a potent stress reducer. Be sure to ask your physician for guidelines relevant to your individual condition, just in case you should steer clear of a particular type of exercise.

Posted in Back Pain on April 17, 2009

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