Chronic lower pack pain may be pyschological rather than physical

Tuesday, May 5, 2009

The following is the first in a series of articles and features on chronic back pain.

"Tell someone who is suffering from ongoing low back pain that it is all in their head and you are likely to get yours bitten off."

That is what I heard from Dr. James Flowers, the director of Sierra Tucson's Pain Management Clinic, during a lecture I endured recently at a San Diego conference while vainly shifting around in my chair, trying to relieve my shrewish lower back pain.

According to this lecture, psychology definitely plays a starring role in pain conditions, especially when the lower back is involved, and even more so when the pain condition becomes chronic.

Dr. Flowers said it plainly: "Beliefs become more disabling than pain itself." He referred primarily to the all too common practice among pain sufferers of catastrophizing -- the belief that the current situation will only get worse and more disabling. Stress itself does not have a direct effect on pain but it does intensify the physical circumstances and interferes with coping. "The lower the level of coping skill, the higher the level of pain intensity."

Dr. Flowers further claimed that the stress from chronic pain can drive a whole host of bad things to the body: increased toxins and decreased absorption of nutrients, limited thinking, increased muscular tension, higher associations with depression and obesity ... and accelerated aging.

I don't qualify yet for the diagnosis of chronic pain; that requires three months. And there is still a chance my mysteriously lingering pain will resolve itself sooner than later -- 90 percent of back pain sufferers resolve it before three months. Yet I am already exhibiting some of the symptoms of someone in the grip of a chronic pain syndrome: restlessness, trouble sleeping, anxious thoughts that this will never end, overfocusing on bodily complaints.

Everyone with back pain seems to notice mine and they all are eager to share their stories of suffering and remedy. Almost everyone I have spoken to is negative on the surgical option. They are not alone. According to one study reported in the Harvard Medical Letter, 97 percent of back surgeries were found to be ineffective in decreasing pain four years after the surgery. Back surgeries have improved considerably in recent years, which may account for a more recent survey by Consumer Reports that found 60 percent of their respondents were happy with the results of their surgery.

It seems a good many of these veterans of the back pain wars have found some professional they declare a "savior" and I now have a whole collection of cards from acupuncturists, chiropractors, physical therapists, and, yes, psychologists. That recent Consumer Report survey (May 2009) supports these more adventurous seekers. They found that the most respondents who were satisfied with their treatment were those who got chiropractic help (59 percent), followed closely by physical therapy and acupuncture. Physicians scored lower (44 percent satisfaction with specialists, 34 percent with primary care doctors).

So many options and so little time to waste. Next week, I will return to this plaguing question of whether my lingering back pain makes me a head case.

Dr. Michael O.L. Seabaugh, a Cape Girardeau native, is a clinical psychologist who lives in Santa Barbara, Calif. Contact him at mseabaugh@semissourian.com For more on the topics covered in Healthspan, visit his website, www.HealthspanWeb.com.

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