The Pain Cycle

May is Mental Health Awareness Month.  Nearly 44 million American adults experience mental health conditions each year, including depression, anxiety or post-traumatic stress disorder, among others.  If you are a chronic back pain sufferer, you may be one of the 44 million Americans who is also managing depression or anxiety.  There are many theories as to how psychological factors influence back pain, but one thing is certain: emotional factors can influence pain.

The Chronic Back Pain Cycle describes how the mind and body work together to cause chronic back pain.  The cycle may begin with feeling pain from a simple back strain.  If this pain begins to interfere with your daily activity, it can cause stress, frustration and anxiety.  This emotional stress can actually cause a physical tightening of the muscles, leading to increased pain, causing more anxiety.  As you can see, the initial pain caused emotional distress which, in turn, caused pain; thus, creating a cycle.

In many cases, the psychological factors drive you to become cautious about engaging in your normal, daily activities in order to avoid pain.  The fear or stress surrounding the avoidance of your daily routine can often be reinforced by friends and family who tell you to take care of yourself or “take it easy”.  Limiting your activities and restricting movements leads to weakening of the muscles and a decrease in strength.  This deconditioning of the muscles can lead to more pain which can lead to more stress, anxiety and depression.

However, if the power of your mind can put you in a cycle of pain and fear, it also has the power to put you in a cycle of recovery and well-being.  Rather than focusing on the pain as a problem, you can understand that most chronic back pain isn’t actually caused by damage to the structures of the back, but rather is due to the effects of muscle tension, stress and inactivity. After receiving a medical evaluation, and learning when it is safe to resume normal activity, the fear and distress that accompanies chronic back pain can diminish.  Positive thoughts and emotions can compete with the pain signal and stop the cycle.  Have you noticed that when you are occupied with doing something you enjoy like having dinner with friends, your pain has lessened?  When your mind feels good, your body feels better, too!

You can utilize these strategies to help minimize your pain and stop the emotional cycle related to your pain.

1. Set goals
a. Pick a goal that is meaningful and achievable.  Choose both physical and emotional goals that keep you moving, your muscles strong and your thoughts positive.

2. Incorporate meditation into your day
. You can start simply, by just taking deep, long breaths for a few minutes at a time.  Take some time away from electronics.  Find a quiet place without distractions for some relaxation.  You can also start incorporating mindfulness into your day.

3. Challenge negative thoughts
. Be aware of your thoughts and recognize when they are negative.  This can happen not only with pain, but also any situation which may cause you to feel upset.  Some experts suggest what is called cognitive restructuring.  Cognitive restructuring is a process in which a person; 1) identifies an event that resulted in a negative or unwanted emotion, 2) considers the thoughts and the types of cognitive errors that he was having at the time of the event that led to the emotion 3) evaluates the thought (e.g., What is the evidence for the thought? What is the evidence against the thought?) and 4) if there is more evidence to suggest the thought might not be true, create a more balanced positive coping thought that is consistent with the facts and evidence.  You can use this worksheet to get started.

The negative feelings associated with an injury or pain can, in fact, lead to more pain in a vicious cycle of fear, stress and pain.  Incorporating enjoyable activities, combating the negative thoughts, using meditation and exercise are all ways that can stop the cycle.  Improved sleep is also beneficial.  If you are experiencing pain, depression or anxiety, the best thing to do would be to consult with your physician.  You can contact us to discuss the best treatment plan to help stop the pain cycle.