Articles

The Emotional Aspects of Back Pain

by Francene Colvin, Ph.D., Psychologist

Depression is often a major psychological condition in patients with chronic back pain. Patients can exhibit a depressed mood, diminished interest in activities, insomnia, loss of appetite, agitation, feelings of worthlessness and loss of hope concerning their healing. In some cases, we see a more severe depression that can lead to suicidal thoughts or acts. Patients may also find it hard to concentrate and solve their problems.

It is often difficult for those of us who are the treating practitioners to differentiate between depressive symptoms that may result from pain and the cognitive/affective symptoms of depression. It may also be difficult for us to make a distinction between discomfort and depression. "I can no longer sit through a movie" may infer either:

• "I can no longer sit comfortably through an entire movie."
• "I have no interest in going out any longer."

Why do patients become depressed in response to their physical problems? Back pain often affects several aspects of a person's life, such as work, leisure, and relationships. It is no wonder that patients may find it difficult to cope when so many aspects of their lives no longer work for them.

A person whose job requires manual labor may no longer be able to continue in the same job. A person who sits at a desk could face similar changes. It is also difficult for those who were once physically active to adjust to limitations of their back ailment. Existing relationships may also present problems to patients with back pain. A patient may feel more dependent on others. We observe that they often need more assistance in their relationships. In other cases, some people may find themselves becoming more withdrawn and less emotionally available.

At The San Francisco Spine Center, we believe that psychological treatment can be valuable to our patients. We offer a support group to assist them during the adjustment period. Our patients can also seek individual therapy, which is often short term and focused on the specific issues upsetting their lives.

We have found that resolving existing conflicts and establishing realistic rehabilitation goals frequently can lessen the depres- sion in our patients.

With more severe depression, medication is often utilized. Alleviating severe depression is a necessary step in creating a successful physical rehabilitation.

Recovering from back pain is similar to other psychological crises. A patient will use similar coping skills as he or she did during other stresses in their lives. Allowing time to heal is an important component in the back patient's treatment plan.

Concurrently, a patient needs to learn control over his or her pain. Loss of the ability to control pain can increase feelings of depression. By gauging the range and intensity of pain, a patient can also learn to manage the numerous feelings which are evoked (anger, disappointment, pessimism), by the experience of pain. When pain is minimized, a patient can accomplish more in his or her life. This can lead to better feelings toward oneself and a more optimistic outlook towards recovering from back problems. In some cases, acceptance of one's physical limitations can also reduce emotional dysphoria. An example is setting a goal of taking a 20 minute walk rather than running a 25 mile marathon.

Never give up hope. There is always a solution to your back pain!