Does Stress Cause Back Pain?

Could my back pain be caused by stress?

No one would disagree that having back and neck pain causes stress, but what about the other way around? Could stress be the primary cause of back pain?

How does stress cause back pain?

There are a variety of theories about the causes of stress related back pain. Importantly, the overriding tenet in all of these theories is that psychological and emotional factors cause some type of physical change resulting in the back pain.

In most theories of stress related back pain, the pain cycle continues and is exacerbated as the pain leads to the patient becoming timid and anxious about daily activities. The pain cycle is characterized by:

                The patient becomes unnecessarily limited in many functions of daily life, as well as leisure activities

                This decrease in activities is due to the patient’s fear of the pain and injury

                This fear may be made worse by admonitions from doctors (and/or family and friends) to “ take it easy” due to some structural diagnosis (which may actually have nothing to do with the back pain)

                The limitations in movement and activity lead to physical reconditioning and muscle weakening, which in turn leads to more back pain

Of course, this cycle results in more pain, more fear, and more physical de-conditioning along with other reactions such as social isolation, depression and anxiety.

The diagnosis of stress related back pain.

The diagnosis of stress related back pain is often made by a through medical history and physical exam. Patients must be cautious in trying to self diagnose stress related back pain, as there may be a serious medical condition (such as a spinal tumor or infection) causing the pain. A good medical examination can usually rule out the more serious structural causes of back pain in a great majority of patients.

For cases of stress-related back pain, the history of onset of back pain is often quite variable. The pain may start with an identifiable incident or it may start insidiously. For instance, it is not uncommon for the pain to start with an incident such as a lower back sprain or strain, only to have it continue as the result of emotional factors long after the injury has healed.

In many cases there may be MRI findings such as a “disc bulge” or “degenerative disc disease” when stress-related back pain is the actual culprit. In theses instances, the MRI findings are not clinically significant and ultimately determined not to be the cause of the pain.

The overall characteristics of stress related back pain include symptoms such as: back pain and or neck pain, diffuse muscle aches, muscle tender points, sleep disturbance and fatigue, in many stress- related back pain cases, patients complain of the pain “moving forward”

In general, symptoms of stress related back pain are similar to those of fibromyalgia. 

Treatments for stress-related back pain.

The multidisciplinary approach to treating stress related back pain includes evaluation of physical,emotional cognitive and environmental factors in all types of back pain problems and develops treatments for each aspect. Thus the multidisciplinary formulation will look at the relative contributions of the following  factors :

•                      physical including de-condition and weak muscles, nerve irritation, etc

•                      emotional including depression, anxiety, anger ,etc

•                      cognitive such as negative thoughts, pessimism, hopelessness, etc.

•                      environmental such as loss of job, financial problems, etc.

This approach then develops a treatment program based upon how much each factor is thought to be influencing the pain. A mulch-disciplinary program may include such treatments as:

•                      treating the physical factors using stretches and exercises recommended by you chiropractor

•                      treating the physical and emotional factors through appropriate medications (often including anti-depressants or muscle relaxants)

•                      treating the emotional and cognitive factors through psychological pain management techniques and biofeedback

The idea of multidisciplinary treatment of back pain has been around for at least 25 years. It has been shown to be quite successful; although, the key factor in treatment outcome is the motivation of the patient to complete a rehabilitation approach.