Researchers interviewed eleven general practitioners (GPs) from New Zealand to get an idea about their general approach to diagnosing back pain, their confidence levels regarding diagnosis and how their approach fits in with current clinical guidelines for treating back pain. The GPs reported:
• Approaching back pain as the result of a tissue injury
• Having low confidence concerning their ability to resolve the problem
• Issuing a diagnosis in order to appease patients
• Advising physical activity in line with clinical guidelines, although this advice admittedly ran counter to the messages they gave patients by describing back pain as the result of a tissue injury
The results of these interviews are troubling because back pain is not always the result of a tissue injury and, when it is, the transition from acute to chronic pain may have little to do with tissue damage. Diagnosing patients with a physical injury when other factors may be at play – particularly psychological factors – can be damaging to the patient’s prognosis.
The idea that a physical injury is definitely linked to pain gives patients the impression that they need to be more careful with themselves. This generally manifests as being less physically active, which is particularly problematic due to the fact that a sedentary lifestyle is a ripe situation for back pain. Muscle conditioning and plenty of fresh blood flow to the various tissues of the back and spine are imperative to back pain recovery. Patients might not understand this when all they are told is that tissues in their backs are damaged.
See more on the study at www.ncbi.nlm.nih.gov.
While this study focused on the impact expectations and beliefs about pain origin potentially have on patient adherence to medical advice, there is another connection between the mind and the body relevant to chronic pain. Psychological factors of pain include anxiety and depression. These may be related to the presence of pain itself, or they may be unrelated. On a biochemical level, emotional and physical pain conditions share a lot – including brain regions where they are processed and the neurotransmitters involved in their perception. Pain can go from acute to chronic if a patient experiences a high level of anxiety around pain, influencing not only his or her behavior, but the components of the nervous system that kick into high gear when experiencing both anxiety and physical pain. An overemphasis on tissue damage, then, can lead to overlooking the immense importance of psychological orientation toward pain.
For their part, patients can acknowledge the other factors involved in pain besides tissue damage and take steps to combat them. The first step is awareness; the second may be seeking out cognitive behavioral therapy. The mind is just as important as the body in many instances of chronic back pain; improve your prognosis by attending to both.