Emotional Causes of Back Pain

"God will forgive you but your nervous system will not" is a favorite quote of ours from Hans Selye, a pioneer in the field of stress research. When you experience back pain and your doctor can't find any structural cause, it's reasonable to assume that your pain might be both a symptom and an expression of some distress in your life that generates troubling emotions.

During the last 35 years, researchers have established that the mind-body connection does exist, and it's actually very simple to understand. Scientists now know that stress hormones trigger chronic inflammation and tension in back muscles, tendons, ligaments, and discs. Muscles that contract (read that as tighten up, sometimes too much) need an opportunity to relax, and when you are stressed, the muscles may stay tight, eventually causing great pain. Therefore it is obvious that stress triggers pain-it's not all in your head. When you experience a psychological (mind) imbalance-for example, when you are chronically angry about a problem at work-you also invariably experience a physiological (body) imbalance.

People under stress are sometimes so uncomfortable they think they are having a heart attack. They experience severe chest pains, shortness of breath, and sometimes nausea. When they go to the emergency room, they are told they were having a panic attack, not a heart attack. If emotions can trigger bodily reactions that mimic a heart attack, it is not difficult to understand how negative emotions can set off some very powerful pain mechanisms in your back. The person who is upset about an impending divorce hearing, the one who is anxious about his wedding, and the one who has been caregiver to her parent for several years will all experience stress differently. One may have a migraine, one may have a panic attack, and the other may find herself laid up with back or neck pain. These reactions can all be stress induced.

Sometimes the in-office evaluation leads us to suspect that a patient's pain may have an emotional cause. (Patients would often prefer that we say something like, "Ahhhh...I see what the trouble is," or even, "Go home, take two aspirin, and call me in the morning.") These are always the most difficult conversations to have.
"What do you mean I'm stressed?!" is often the response from patients when we mention that a decrease in stress might lead to a decrease in back pain. Although most of us are conditioned to believe that it is a weakness if we have a physical manifestation of how we are feeling, I am here to tell you that's crazy. We all have emotions, and they are going to come out somehow.

Life stresses-and our often negative reactions to them in the form of anger, distress, or fear-are also major triggers of both acute and chronic back pain. Think about it:

• If you're afraid of, or don't enjoy, public speaking or flying, how does your body feel in the hours before a speech or a flight?
• How do you feel when you are waiting for an important phone call, such as news from your parent or child, the outcome of a job interview, or the results of a medical test? How is your breathing? What do you do while waiting? Can you concentrate? Do you have any aches or pains?

When you stop and think about it, you know there is a mind-body connection. Every thought and feeling coexists with a set of neurological, hormonal, and even immune-system changes. Your entire biochemistry from moment to moment affects, and is affected by, your thought patterns and emotions. Altered breathing often accompanies these situations and can add to your discomfort. People hold their breath when frightened; they take shallow breaths when nervous-these factors contribute to body pain. When you breathe less deeply, oxygen and nutrients do not circulate around your body at the optimum rate, which results in the formation of a toxic environment. Your muscles tighten up, and you may be in pain until your body has a chance to loosen up.

One Friday, a patient, who is also a friend, called me as he was walking to work. His back was killing him, and he reported that it came "out of the blue." He mentioned that he had a big conference coming up, and he couldn't afford to be sick or have anything be wrong.
I asked him, "Did you do anything differently, strain yourself or sleep on a different mattress?"
The answer was no.
"Did you eat anything differently? Are you feverish? Have your bowel movements been different or are you having any problems while urinating?"
"No."
"Are you feeling stressed?"
"Yes!"
"Bingo," I told him.

Back pain doesn't come from nowhere. If my friend had been eating properly and had no particular reason to worry about a structural issue, then stress was the likely culprit. His muscles were on overdrive because of emotional strain. Some people get headaches, other people's jaws clamp up; still others feel the tightness in their backs.

We talked for a few more minutes about the upcoming conference he was worried about, and we discussed his options: Could he knock off work early that day (no), go for a massage Saturday morning (another no), or at least sleep a little extra Friday night (yes)?

When I called him the following Saturday, his back pain was gone. He said that simply figuring out that it was stress allowed him to calm down a bit.