Pain and emotions

Back Pain and Emotions: When Pain Isn't Explained by the Back Alone

How persistent pain, the nervous system and what we feel are connected.

Many people with persistent back pain have been through tests, treatments and even surgery. And they still have pain. Sometimes the structure doesn't explain everything.

What we know

A review of 85 studies with more than 826,000 adults found that people who experienced abuse, neglect or other adverse experiences in childhood are more likely to have chronic pain as adults (around 45% higher odds), and that the likelihood rises with the number of experiences (Bussières et al., 2023). It doesn't say back pain has an emotional origin: it says a person's history and their pain are not separate things.

How we deal with what we feel also matters. Avoiding or suppressing emotions, such as anger, has been linked to greater sensitivity to pain (IASP, Treating emotional problems in pain).

In low back pain, a cycle has also been described: pain creates fear that movement will make it worse, that fear leads to avoiding activities, and inactivity and hypervigilance can keep the pain going. This is the fear-avoidance model (Leeuw et al., 2007). Its scientific support is debated on some points, so I present it as a way of understanding what happens, not as a rule.

What central sensitization has to do with it

When pain lasts a long time, the nervous system can become more sensitive and amplify signals, even when the tissue is no longer damaged. This is central sensitization. Stress, fear and difficult experiences can keep that system on alert. That's why, with back pain that doesn't improve, looking only at the spine can fall short.

What visceral osteopathy can do for you

Working on the structures that keep the nervous system on alert:

• The central nervous system, with craniosacral therapy, aiming to release tension around the vagus nerve and the phrenic nerve.
• The rib cage, restoring its mobility to release the mediastinum and the diaphragm.
• The kidneys and adrenal glands, which release cortisol, the stress hormone, and which in my experience are related to fear and the feeling of being on the defensive. This is the area I talk about in this article on cortisol.

If yours is failed back surgery

If you've already had surgery, this other article is for you.

Sources

Bussières A, Hancock MJ, Elklit A, et al. Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: a systematic review and meta-analysis. European Journal of Psychotraumatology. 2023;14(2):2284025. DOI: 10.1080/20008066.2023.2284025

IASP. Treating emotional problems in pain. Pain Relief News. iasp-pain.org

Leeuw M, Goossens MEJB, Linton SJ, et al. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. Journal of Behavioral Medicine. 2007;30:77–94. DOI: 10.1007/s10865-006-9085-0