Back Pain and Emotional Distress


Pain is a complex experience that includes both physical and psychological
factors. Pain can be defined as “an unpleasant sensory and emotional experience
associated with actual or potential damage, or described in terms of such
damage.” Acute pain can frequently lead to emotional reactions such as fear
and anxiety.
A large part of the fear and anxiety that accompany spinal pain is the
unknown underlying cause of the pain and the uncertainty around the effect
that this may have on the patient’s everyday life.
Knowledge about the condition, the treatment and expected outcome is paramount
in countering the emotional reaction associated with the pain and aids
in faster and more complete recovery.
Important steps in conquering the emotional effects of pain
1. The underlying condition must be diagnosed and defined.
2. The expected treatment and possible success should be outlined.
3. The prognosis should be established.
4. Both physical therapy and treatment to reduce pain should be instituted as
promptly as possible, as this will prevent a cycle of ongoing pain and fear to

What do you need to know?
Understanding your condition is paramount for successful treatment. It is
important to ask your specialist as many questions as you can.
When you have asked all your questions and have made sure that you understand
the answers, you should write them down and then do thorough
research. Talking to other patients is rarely helpful, as they would most likely
have a different cause for their back pain and misinformation is much more
dangerous than no information. Other patients will also frequently have preconceptions
and misconceptions about the nature of back pain as well as its
The internet is a good source of information, as are information leaflets and
books written by professionals. It is important to go back to your specialist
following your research and clarify anything that you are still not sure about.
The (vicious) cycle of pain
The effects of acute pain are many and varied. Acute pain can cause enormous
amounts of stress and anxiety in patients. The factor of the unknown,
the reduced ability to deal with everyday life, anger, uncertainty and fear
combine in a heady cocktail that can spell disaster. Certain types of personality
traits and also certain perceptions or misconceptions add fuel to the fire.
Think for instance of the anxious type of person who has seen a family member
have a bad experience with spinal pain, perhaps compounded by unsuccessful
treatment or surgery.
The enormous amount of stress that the pain, the associated fear and anxiety
and burdens of everyday life can place on a person are usually detrimental to
a normal sleeping pattern. If you add the physical effects of pain, a vicious
cycle develops.
During certain stages of deep sleep, an important hormone called serotonin is
released by the body. This is a natural pain killer (endorphin, so-called
because it is the body’s own morphine) and is also important in combating
depression. Reduced sleep leads to fatigue, which makes the perception of
pain more acute and also reduces the levels of endorphins (serotonin) secreted
because of lack of sleep. This reduces the body’s ability to fight pain and
causes depression.
Making sure that you sleep properly is therefore of paramount importance.
This can be achieved by ensuring that you have adequate pain relief from
anti-inflammatory medication as well as simple analgesics and that their
administration times allow you to have a good night’s rest. Certain drugs such
as amytriptiline increase the levels of serotonin and are also sedative without
having addictive properties and can be taken on a chronic basis.
In patients where neglected pain is not managed properly and promptly,
chronic pain may develop. The problem with chronic pain is that instead of
becoming used to pain, patients become less able to deal with pain and their
perception of pain changes. This means that instead of being able to tolerate
pain better, they become less tolerant of pain and even if treatment at this
stage is partially successful, the level of pain that would previously have been
perceived as acceptable or tolerable, is now perceived as intolerable.
Action plan to avoid depression and anxiety associated with pain
1. Know and understand the source of the pain.
2. Understand the consequences of the condition as well as the long-term outlook.
3. Understand the possible treatment as well as your individual treatment plan
and make sure that you do not have unrealistic expectations.
4. Make sure you follow the treatment to the letter as well as any physical
therapy that is prescribed. Report back if the treatment is not effective so that
your specialist may adjust your treatment.
5. Sleep is of paramount importance; this cannot be stressed enough.
6. Adjust your daily activities to cope with your condition. Be frank with your
employer and make them part of your rehabilitation process. Keep them
updated and they will support you much better than if you hide your condition
or keep them in the dark.
7. Depression and anxiety are normal adaptive responses to severe pain and
if these manifest, treatment by a professional that may include counseling as
well as antidepressants can be invaluable.