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Is Back Pain All in Your Head?

Post by Brian Yee, PT, MPhty, OCS, FAAOMPT

What a great article from NPR! This article identifies that recurring back problems are not solely from the structure in your spine such as a herniated disc or degeneration or the vertebra, but rather it brings attention to the nervous system itself. Your nervous system, located within your spine, is your main transducer that signals to your brain that you are or are not in pain. This article states:

“Research is showing that the pain often has nothing to do with the mechanics of the spine, but with the way the nervous system is behaving, according to Dr. James Rainville of New England Baptist Hospital in Boston.”

“This is a different way of thinking about pain. Normally pain is an alarm bell that says, ‘Stop what you’re doing right now or you may hurt yourself!’ But for many people, that pain is a false signal. It’s not about looming danger, it’s actually caused by hypersensitive nerves.”

Think of a chemistry set where you are mixing reactive chemicals together. If you know anything about action potentials, the onset of back pain is like the last drop of a certain chemical that you put into a solution and causes the action potential to occur that makes it explode.

Normally, the nervous system can handle a lot of sensory information that does not cause it to react in such a way, but with excessive or repetitive stimulus to the nervous system it can lead to that action potential we mentioned. Such stimulus could be from typical mechanical reasons such as too much load or torque from lifting heavy weight or prolonged sitting with poor posture. But it could also come from unexpected stimulus that can make the nervous system more “sensitive” or prone to irritation… such as increased stress levels or depression; temperature changes either hot or cold; or shared nerve innervations from an irritated and inflamed internal organ and more.

All of these stimuli either in isolation or by accumulative effect can make the nerves around your back reach that action potential state to cause episodic back pain. So with this perspective, solely performing surgery, prescribing medications, or injections become limited in its capacity to fully treat the contributing factors that may cause the nerves in your back to become reactive.

In my experience in working with back pain, each patient’s case is unique in its own sense, as every person has their own causative factors. In Physical Therapy, we are trained to discuss and learn about the major factors that can contribute to a person’s back pain before we simply start a protocol based program that does not view the person as an individual. Some treatment may focus on the mechanics of the spine, as well as the upper and lower body. Some other treatments may focus on calming the nervous system down with hands on techniques or modalities. While other times, we may spend time simply discussing with the patient about their perspectives to their pain and how their own fear or anxiety about their pain may be causing them to have prolonged pain patterns.

The end of this article by NPR continues to talk about a back pain boot camp program that encourages patients with chronic back pain that have fear of hurting their back with increased activity. They use a graded feedback approach that allows the patient to exercise with low level of discomfort, and over time progress their exercise or weight without aggravating their pain. As the patient improves in increased fitness capacity, it demonstrates to the patient that they are gaining ownership over their pain. This, in turn, helps calm the nervous system down by lowering anxiety or depression and its chemical reaction to the nerves in their back.

This just one of many approaches for patients with back pain to help them de-sensitize the irritated nerves in your back.

I hope more articles like this come out that brings to light that treating the person as a whole can be more beneficial than just a single structure.

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