And now just a word about pain

Back pain, any pain, is weirder than you think.

In this series of blog posts I’ve been summarising some myths and misconceptions around back pain.  We’ve seen that things commonly thought to lead to bad backs like poor posture, spinal deviations, too much sitting, lifting or twisting and carrying heavy school bags if you’re a child are not especially dangerous at all.  Further, the evidence is apparently telling us that the protective behaviours people with back pain often adopt, like avoidance of exercise or particular movements, resting in bed and adopting altered postures are not helpful and may make matters worse.

It turns out that pain in general and back pain in particular is a lot more complicated than most of us think.  When it comes to backs, our natural assumption that pain equals damage just isn’t reliable.  We hurt for a many reasons and no two people experience pain the same way.  Our particular history, stresses, fears, anxieties, and expectations strongly influence how we feel pain, often more than the state of our tissues, especially when it comes to chronic pain. And especially when it comes to our backs.

What research is showing is that once people with back pain can distinguish between the 'hurt' they are feeling and any concerns they may have about 'harm' being done to their back, it is easier for them to participate in treatment.  When it becomes possible to say “I can do this movement (or exercise or whatever) even though it hurts because I know it’s not causing any damage to my back”, then treatment, any treatment, is going to be more effective.

And there are many things people can do to ease the pain apart from treatment.  For example, back pain is almost always worse and persists longer if you don’t sleep well.  So anything you can do to improve sleep is going to help.  Similarly, low mood, stress and anxiety make pain worse so managing these things by engaging in activities you enjoy and finding ways to relax will be beneficial.

Exercise is another great self-help tool.  Almost any exercise is beneficial when it comes to back pain according to the latest research, so you can just pick one you enjoy, can afford and find convenient.

Of course, when you’re sore it’s harder to sleep properly or focus on positive feelings or exercise. This is why therapists working with people who have chronic back pain are being encouraged to adopt a more flexible approach which focuses on each individual’s specific circumstances and challenges.  For the therapist, this may involve learning more ways to help (with exercise or sleep or stress management for example) or it may mean developing a good referral network.

The bottom line is that back pain CAN get better even when it's persistent.  We all need to be aware of the various myths that surround this very common problem and recognise that solutions which address each person’s particular issues will be the most effective.