Five negative thoughts that can prolong back pain

Growing evidence suggests the way you think and feel about your back pain plays an important role in your chances of recovery.

Thinking negatively about the prospects of getting better, as well as feelings of stress and anxiety, can extend the length of time you suffer with back pain. 

Experts now look for these psychological factors, or "yellow flags", as they signal these people have a higher risk of not recovering as quickly.

"Psychological factors are the most consistent predictors of who will develop chronic back pain and who won't recover, so they're really central to effective prevention and treatment," says Dr Adam Al-Kashi, head of research at BackCare.

The early identification and management of psychological factors has been found to be effective at preventing long-term back pain. Treatments to address the psychological element of your back pain may be offered together with some type of manual therapy, such as physiotherapy or osteopathy.

If you have back pain and strongly agree with four out of the five statements below, you are considered to be at high risk of long-term back pain. 

  • "It's not really safe for a person with a condition like mine to be physically active"

In the vast majority of cases, pain in your back doesn't mean there's something physically wrong with your back, in the same way that a headache is generally not caused by something wrong in the brain.

The belief that back pain is a sign of physical injury or damage often causes people to avoid physical activities for fear they'll make things worse. In fact, this kind of "fear avoidance" behaviour predicts long-term pain and disability. It is best addressed using a fear-reduction treatment, such as a tailored programme of cognitive behavioural therapy (CBT).

  • "Worrying thoughts have been going through my head a lot of the time"

Stress, tension and anxiety make you more likely to develop back pain and less likely to recover. Patients often don't realise how much of a difference stress can make to their chances of recovery. Talking therapies, such as counselling, are considered an effective treatment when stress or anxiety has been identified.

  • "I feel my back pain is terrible and it's never going to get any better"

There is good evidence to suggest that people who have a tendency to assume the worst (catastrophise) and dwell on negative things (ruminate) take longer to recover from an episode of back pain. Talking therapies such as CBT can improve recovery by giving you more productive and less stressful ways of thinking.

  • "In general, I have not enjoyed the things I used to enjoy"

When you feel back pain is taking over your life and makes it impossible for you to enjoy everyday activities, this indicates you've not managed to find a way or strategy to cope with the pain. Again, talking therapies are considered an effective treatment.

  • "Overall, my back pain has been very bothersome in the last two weeks"

The more you are "bothered", "troubled" or "burdened" by pain, the longer it will take to recover. This doesn't mean you should ignore pain, but research shows that how you feel about the pain predicts your chances of making a speedy recovery. Again, talking therapies such as CBT are recommended.

Page last reviewed: 31/10/2014

Next review due: 31/10/2016

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