Back problems: the problematic is psychosomatic

We have a tendency to underrate the psychosomatic causes of back pain. According to one study, the roots of 16-31% of all illnesses are psychosomatic. This percentage is even higher for back-related illnesses and back pain.

possible causes of back pain

Eighty to ninety percent of people who suffer chronic back pain also show mild depressive symptoms. Admittedly, there are other factors that contribute to back pain. Nevertheless, half to three quarters of all people suffering back pain are mainly experiencing psychological rather than physical symptoms.

For example, stress is the main cause of all types of back pain. We do not use figures of speech such as ‘to have a weight on one’s shoulders’ for no reason. Long-term strain on the psyche is proven to have effects on the body as well. When we become stressed, our back musculature tightens. This reaction developed over the course of evolution; when a person enters a tense situation, their body releases adrenaline. This ‘stress hormone’ primes our muscles for a fight or flight response.

If a sabre-toothed tiger stalked into a cave, our ancestors needed to be able to put all their strength in the field to fight the threat. The human response to stress has remained the same since prehistoric times, although today we are rarely confronted with matters of life and death. Least of all in the office, where the current homo sapiens experiences the most stress. Unlike our forebears, the adrenaline in the blood of modern humans is used to overcome intellectual rather than physical challenges. Our adrenaline levels have remained the same, but the stress hormone is no longer used to fuel our muscles in hand-to-hand fights for survival. Muscle tension results. If muscle tension or stress becomes long-term, the release of adrenaline leads to back pain.

A further difference between our ancestors and modern man is the amount of time we are exposed to stress. Whilst our forebears experienced acute periods of stress, modern man is forced to live with chronic stress. Whilst acute stress is healthy and improves performance, chronic stress detracts from good health and leads to physical symptoms such as back pain.

What does ‘psychosomatic’ mean?

As is now abundantly clear, the long-term consequences of chronic stress include back pain whose origins are psychosomatic. However, there is significant stigma attached to this term. It is important to note that ‘psychosomatic’ does not mean that back pain is merely in the sufferer’s imagination. On the contrary, psychosomatic pain is very real, and people who suffer it suffer equally or more debilitating effects than people whose pain has purely physical origins.<

To begin with, ‘somatic’ means ‘of or relating to the soma’ (the body). Hence, ‘psychosomatic’ means the interaction between the physical and the mental. In other words, psychosomatic pain is pain whose origin is psychological; it is not pain that is simply imagined.

The interaction between the mental and physical causes of back pain has been recognised for a long time. In the nineties, researches discovered that only few people who suffer chronic back pain have sustained physical damage to their spine or spinal discs. In most cases, people suffered from issues such as a weak back musculature, a partially stiff back or fitness problems. The researchers found that psychological issues increase the effect of physical causes of pain and also lower an individual’s pain threshold.

One of the reasons for this is that the endocrine system of a depressed or depressive individual releases less pain-relieving hormones than those of a person in full health. A depressive or depressed person experiences physical pain more acutely than someone in peak mental health.

Long-term strain causes back pain

Bullying, stress, feeling overwhelmed and bad strokes of fate can put the body into a permanent state of emergency. A study indicates that 85 percent of all back pain has psychological causes. Mental illness can also prevent physical pain from receding once a physical cause of pain has been treated. Most psychosomatic roots of back pain can be attributed to the workplace. A bad working environment, time pressures, conflict with your co-workers, overtime work, a lack of recognition from your co-workers or superiors, having to be available after hours or fear of an impending dismissal are some of the many reasons for the increase in psychosomatic back pain among employees. Also, do not underrate the impact of your personal life on stress levels at work.

A death in the family, the need to admit a relative to intensive care, relationship or marital tensions, drawn-out conflict with family or your circle of friends and a stressful personal life can also cause chronic back pain. In some cases, the sum of a lot of small factors can cause a large amount of stress. Equally sufficient causes are a pessimistic personality; chronic cynicism; the bombardment of bad news from news services, the radio, mobile phone apps and social networks as well as general disillusionment. A failure to balance a demanding workday with other activities can also have physical effects.

How to avert a crisis

It should already be clear that not all back pain has psychological origins. If you have a slipped or damaged spinal disk or muscle tightness, you should see an orthopaedic surgeon or physiotherapist. These experts will be able to alleviate any physical components of a serious back problem with a view to relieving your pain. Psychosomatic illness is more difficult to treat, and so are cases in which somatic and psychosomatic causes of pain interact.

A diagnosis that indicates a mental cause of pain is generally not well received. In America, there is a culture of psychological therapy; however, in Europe people tend to have a low opinion of those who cannot or do not want to solve their problems on their own. Most people view the mention of psychosomatics as downplaying their ‘real’ problem. Many people regard a diagnosis that includes psychosomatic causes of pain as the mark of a doctor who is incapable of diagnosing the real causes of their back pain. Hence, doctors may be hesitant to point to the actual psychosomatic origins of pain and instead prescribe painkillers or physiotherapy because they do not want to lose their patients to another doctor.

In such cases, the real problem remains untreated and a short-term psychosomatic problem becomes a chronic illness. It is not often recognised that psychosomatic causes are the physical manifestation of a mental problem. Indeed, such recognition is uncommon among doctors and patients alike. If the soul’s cries for help are consistently ignored, your back pain will assume a downward spiral. Your back will continue to ache, and your increased anxiousness about your back pain will amplify its psychological causes, such as stress. Your back pain may become the catalyst for more serious back problems.

The first step is for patients to accept the psychological causes of their pain and to deal with these causes. For example, an employee suffering chronic stress should learn how to say ‘No!’ to extra work. Too much work and resulting time pressures can spill over into your private life and create tension at home. The result is a growing sense of disillusionment. Muscle tension leads to chronic back pain, possibly even nerve pain. Because the original cause of pain is ignored, people then come to the conclusion that their pain is purely physical. However, the physical pain is simply a consequence of a failure to treat existing psychological and lifestyle problems. People treat their physical symptoms without any regard for its underlying psychosomatic causes. People suffering back pain may be accused of trying to avoid work and of not pulling their weight. Such accusations can lead to workplace bulling and warnings from your employer. Simply put, purely psychological stress can become stress that is perceived through the body, and this results in a downward spiral of more stress and pain. Experts refer to a vicious cycle because mental suffering entails physical pain, which again increases mental suffering—repeat ad nauseam.

Experts state that the path to self-knowledge is the path to recovery. It is a good idea to check in with yourself on a regular basis. Ask yourself whether there is one aspect of your life that you are neglecting. Does your work give you enough time to have a fulfilling relationship, maintain your friendships and to travel to the places you have wanted to see since you were a child? Have you put enough energy into the realisation of these goals or instead followed the path of least resistance? It is easier to let yourself drift rather than to work towards a goal, but it is also less fulfilling. Sometimes a sense of helplessness, guilt, fear or duty prevents people from taking care of their own needs. Listening to your body is the first step in generating an ‘upwards spiral’. This positive change can be assisted by professional help.

Professional help

Your GP should be your first port of call. They are likely to have known you for a longer time than a specialist; they will able to accurately diagnose your problems. If you talk to your GP about your back pain and indicate that there may be more than physical factors at play, you have taken the first step towards recovery. Your GP will work together with specialists to determine whether or not there are physical causes of your pack pain. They may then suggest a suitable therapist. In any case, the road to recovery from back pain starts when you recognise ‘psychosomatic’ as a real cause of pain and treat it accordingly.

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