Negative Beliefs Worsen Chronic Pain and Depression in Patients with Back Problems

Despite advances in treating physical pain, many people with back pain continue to suffer. Researchers have found that negative beliefs and depression can be major factors for perpetuating chronic back pain. If the emotional component of chronic pain is not addressed, pain and disability worsen.

How Negative Beliefs Affect Chronic Pain

A recent Australian study (reported by MedlinePlus) found that patients with back pain who had negative beliefs about their pain had more disability and more persistent pain. Patients with negative beliefs that included catastrophic thinking (worry that back pain indicates underlying physical damage that could result in "a hopeless situation") had increased disability.

Brain mapping studies explain why some people develop negative beliefs about pain and others don't. During the experience of pain, the part of the brain that controls perception is also activated. This area of the brain governs how we evaluate the unpleasantness of our pain, giving credence to the view that pain consists of both a physical sensation and an emotional response. The perceptions of humans vary widely. One may form negative beliefs about back pain while another may relate more to the physical experience without drawing conclusions about it.

When negative beliefs cause back pain sufferers to limit movement in an attempt to avoid pain, they begin to withdraw from normal activities. Depression may result. Depression and stress worsen the pain, and pain worsens depression, perpetuating a vicious cycle.

Conversely, in the absence of negative beliefs and with the distraction of doing something enjoyable, back pain can be diminished. Stress reduction techniques have been successful in reducing perceived severity of chronic pain.

Treating the Emotional Component of Pain

In 2009, American Pain Society's treatment guidelines for people with low back pain began including cognitive therapy as a part of pain management.

The American Psychological Association (APA) recommends that patients with chronic pain try to reframe negative beliefs and avoid seeing themselves as powerless and unable to cope. Instead, people with chronic pain can acknowledge their discomfort but look for healthy ways to think about and cope with pain.

American Chronic Pain Association recommends learning to relax and redirect attention away from negative beliefs and onto things that one can control. They recommend reasonable activity that allows the body to remain flexible and reduces the sense of suffering.

Summary

People with chronic back pain who hold negative beliefs and engage in catastrophic thinking have increased pain and disability. Increased pain and disability cause avoidance of movement. Avoidance of movement causes the tasks of daily living to go unaccomplished, often contributing to depression. Depression worsens pain and pain worsens depression. Patients who cannot reframe negative beliefs would likely benefit from consulting a mental health professional to find positive ways of coping with chronic pain.

Sources:

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William Deardorff.Four Tips to Help Cope with Chronic Pain and Depression. Spine-Health.

Donna M Urquhart, Robin J Bell, Flavia M Cicuttini, Jisheng Cui,Andrew Forbes, Susan R. Davis. Negative beliefs about low back pain are associated with high pain intensity and high level disability in community-based women. Biomed Central.

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