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Back pain: One overlooked risk factor that can make your symptoms worse

Back pain is a widely reported complaint in the UK, with more than one in three people living with the condition.

Lower back pain tends to be the most common.

It is usually caused by picking something up awkwardly or bad posture.

One often overlooked but significant factor that can prevent recovery and make symptoms worse is the toll back pain can take on a person emotionally.

It’s important that you keep active


According to Bupa, emotional factors that can increase the risk of a person’s back pain becoming chronic include:

  • Believing that pain and activity are harmful. These may be a person’s own beliefs, but they can be reinforced by family members who may be trying to protect them.
  • Negative actions can reinforce the belief that a person is unwell – for example, staying in bed for a long time.
  • Having a low or negative mood, depression, anxiety or stress.
  • Having low expectations of how well treatment will work.
  • Relying too much on passive treatments (ones that don’t expect a person to do anything) such as painkillers, hot and cold packs, massage and electrotherapy.

The health body added: “Although you may think your pain is a warning sign to stop you doing certain activities, it’s important that you keep active to overcome it.”

People can seek psychological support to aid their back recovery.

The NHS recommends trying cognitive behavioural therapy (CBT) – this can be a useful part of treatment if a person is struggling to cope with their pain.

CBT, along with mindfulness techniques, have been proven to help chronic back pain.

Among adults with chronic low back pain, both mindfulness-based stress reduction and cognitive behavioural therapy resulted in greater improvement in back pain and functional limitations when compared with usual care, according to a study published in Jama.

Mindfulness-based stress reduction (MBSR) focuses on increasing awareness and acceptance of moment-to-moment experiences including physical discomfort and difficult emotions.

Daniel C. Cherkin, Ph.D., of Group Health Research Institute, Seattle, and colleagues randomly assigned 342 adults age 20 to 70 years with chronic low back pain to receive MBSR, cognitive behavioural therapy, or usual care.

CBT and MBSR were delivered in eight weekly two-hour groups.

Usual care included whatever other treatment, if any, the participants received.

The average age of the participants was 49 years; the average duration of back pain was 7.3 years.

The researchers found that at 26 weeks, the percentage of participants with clinically meaningful improvement on a measure of functional limitations was higher for those who received MBSR (61 percent) and CBT (58 percent) than for usual care (44 per cent).

The percentage of participants with clinically meaningful improvement in pain bothersomeness at 26 weeks was 44 per cent in the MBSR group and 45 per cent in the CBT group, versus 27 per cent in the usual care group.

Findings for MBSR persisted with little change at 52 weeks for both primary outcomes.

Commenting on the findings, the study authors said: “The effects were moderate in size, which has been typical of evidence-based treatments recommended for chronic low back pain.

“These benefits are remarkable given that only 51 percent of those randomised to receive MBSR and 57 per cent of those randomised to receive CBT attended at least six of the eight sessions.

“These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain.”

As Bupa explained: “Psychological therapy centres on educating you to identify things that cause or aggravate your pain, and strategies you can use to deal with the pain.”

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