Step 7 – Psychology

Psychological Effects On Pain

I wanted to save this section until last, because the nature of the mind is so quirky and difficult to penetrate. The nature of the mind can be affected by changes in the physical world around us and hopefully the first six steps of this program have introduced some physical and habit changes that are already making you feel better.

The sense of feeling better will give rise to new ways to think and act. Your thoughts and behavior will alter your perception of pain and put you more in control of it. The unfortunate thing about pain is that it is invisible, even when it is severe. There is no study that can definitively confirm your pain. This is especially true when there are no hard findings on a scan, such as an MRI or CT scan.

Is it really just in your head?

One of the saddest situations I get to see, is some subtle soft tissue problem that causes lots of pain and can be treated, but has not been diagnosed or recognized. A medical professional that doesn’t recognize the nature of a pain problem may make the flippant comment that it’s in your head, and people wonder if they are crazy, in addition to having the back pain. On the other hand, the attitude that surrounds a back pain issue can greatly influence the effect it will have on one’s life.

For example, a work-related injury that affects the back is much less likely to get better with the same treatments given to people with the same non-work related problem. This phenomenon is well documented and often makes it necessary to separate the two groups (work-related and non work-related) in research studies.

This effect is primarily psychological and may occur for various reasons. In the work related situation one might say, I hate my job or There is no way I want to return to a job that might cause a recurrence of this kind of pain, or my claim is not worth as much if I don’t hurt. These certainly are not statements that are linked with the idea of having the pain going away or having less pain. In other words, there is a strong psychological reason for the pain to persist.

Back pain can be magnified or diminished with differing psychological outlooks. These points of view are important to recognize and realize that back pain can be used (not always consciously) to manipulate people and surroundings in ways that would not be possible without having the pain, a process referred to as secondary gains. The pain can also be a legitimate reason for the excessive use of narcotics, muscle relaxants and alcohol. Especially since it is common to develop a tolerance that requires a higher dosing with time, in order to remain effective.

I mention these pitfalls only to be aware of them and possibly seek counseling if they might be a problem. Chronic back pain causes changes in your activity levels, both social and physical, and usually not for the better. Inability to participate in social activities as once before, can lead to isolation and a lessening of friend and family support.

Unfortunately they cannot see the pain that holds you back. It’s hard to fake feeling good when you don’t feel good.

Engaging in a physical activity that might aggravate the pain just isn’t in the cards and that includes lifting and playing with the kids. It turns into a vicious circle of isolation, a circle with an invisible boundary of pain. No matter what level of physical activity you were involved in before your pain began, it will lessen with any significant level of pain. If you are hard charging and determined to work through the pain, know that this strategy usually doesn’t work.

The psychology of chronic back pain often includes a mixture of the above influences to one extent or another and often results in two psychological conditions, depression and stress. These are states of mind that are controlled by the chemistry of the brain. This chemistry can be influenced by physical events and activities that are the basis of the first six steps of this program.

Do not underestimate your mind

The first six steps were designed to make you feel better. The chemistry of your brain can be changed by certain physical activities, particularly exercise, and empowered by better choices of food, drink, vitamins, and nutrients. You cannot underestimate the power of your mind to influence the pain you are experiencing. The state of mind that you generate can amplify your symptoms or minimize them.

What you think about all the time, will often get you more of what you think about. If you think about your pain and how terrible it is all the time, you are giving it more life and control of your life. On the other hand, separating yourself from your pain (I am not my pain) will give you more control over your pain. This is not to say that you can will it away, but sometimes you can coexist with it.

In the end, one of three situations will exist:

  • You will have moved to a state of complete healing where you have no more symptoms.
  • You will have some underlying continuous or intermittent pain that you have learned to coexist with.
  • You have a problem that needs further evaluation and treatment.

Probably the number one aggravator of neck or back pain is stress. Stress is mediated in part by cortisol. Unlike times past, when stress took the form of a saber-tooth tiger jumping out from behind a bush and pushing our cortisol levels through the roof, modern day life is quite different. We rarely get high spiking levels of stress and cortisol, but rather exist with a continuous low level of aggravation.

Examples of low-level stressors are stop and go traffic, expectations at work, trying to balance your inner peace or personal desires with the expectations of the world that surrounds you, and eating foods with a high glycemic index. All of this leads to a certain level of uneasiness or stress that is not really an effective state of mind. Wouldn’t it just be better to make a decision and relax, or just know that you are doing your best and relax, or just know that you are stuck in traffic and relax. When the guy in front of you cuts you off, so what?

Remember, it is your reaction to something occurring, not the event itself. You want Peace of Mind to become the default state of mind where stress is the enemy.

Work on Stress Reduction Techniques

I think one great approach to minimize stress is to practice some sort of mind relaxation technique on a daily basis. Sometimes these techniques are referred to as meditation which can be difficult and time-consuming to learn. If the learning takes too long it is unlikely that you will stick with it long enough to develop a daily practice. Fortunately, some people have developed sound tracks to induce relaxation, sometimes referred to as brainwave entrainment or synchronization signals. These soundtracks must be listened to with headphones with any noise cancelling turned off. The sounds induce a relaxed state of mind in a very short period of time (20-30 minutes) without any practice or preparation. These sound tracks are made to stimulate alpha, delta, and theta brainwaves that are relaxing, rejuvenating, and possibly healing in nature.

There are several of these products on the internet at varying prices. One good example of this technology at a great price is Equisync (less than $100), which sends you three discs that emphasize different frequencies. Another is Holosync that can help you achieve a feeling of relaxation and Dzonenessdz with the world. The Holosync developer, Bill Wilson, is so confident of his product that he will accept a return of the product within a year of purchase! How can you afford not to try this technology? This is not airy-fairy hocus pocus stuff, it is a real means to reduce stress.

Depression is a chemically induced state of mind that is common to accompany chronic pain states. Living with chronic pain can be depressing, no doubt. Just being unable to do all the things that one used to do, can lead to depression. This is not a state of mental weakness, it is a response to a situation that is not what you expected or wanted, it is situational. The amount of antidepressant medication advertised and sold in the United States is staggering and there is no doubt that it can be helpful, especially in conjunction with some counseling. However, if certain activities, diet choices, or easily induced states of mind can alter or relieve a state of stress and depression, wouldn’t that be worthwhile and preferred?

Keep working the first six steps and see what changes you can make in your life.

Action Steps

Step 1

Implement the first six steps of this program as you are able. Be patient with yourself, it’s going to take some time. Watch for and focus on little gains and improvements in your life. Keep a journal of your progress, including level of activity, amount of pain medications, hours of sleep you get and anything else that makes you feel better. If you feel psychologically challenged, consider the next four points.

Step 2

Remember that an increased level of physical activity is associated with a decreased level of depression.

Step 3

Check out the possibility of using brainwave entrainment technology on a daily basis to reduce stress. If you are not a seasoned meditator, consider purchasing a program like Equisync or Holosync sound tracks from the Internet. Just 20-30 minutes a day can really help you get a more relaxed state of mind. These will save you a lot of time and have a high rate of customer satisfaction. Get your headphones ready.

Step 4

Consider counseling. Another person’s point of view can be so valuable at times to point out faulty or dead-end ways of doing things.

Step 5

Medications can be very helpful to change your internal chemistry and lift your mood. They can also help you to get more sleep at night. There is evidence showing that medications work best in conjunction with counseling. Medications are prescribed and monitored by a medical professional.

Congratulations! You have finished all 7 steps.

This certainly demonstrates your commitment to improve your back pain and optimize your body’s healing potential. Hopefully you are feeling better. If these steps have not helped, you most likely have a mechanical problem that needs additional evaluation be a medical professional.

These are the steps I took in relieving my back pain that I hope will never return. Thank you very much for participating!

– Tony Mork, MD