Science has shown that there is an incredibly powerful link between the mind and the body. Most times, the underlying cause of neck, back and sciatic pain, also known as back pain complex, may be psychological. Often, when a person is in pain and is told that it may be psychological or psychosomatic, the patient immediately becomes defensive, often stating, “It’s not in my head, the pain is real!” In reality, it is real, whether we label the pain psychosomatic. When dealing with chronic pain that is resistant to treatment, the mind-body connection must be explored in order to rule it out. In this article, we will discuss psychological pain, psychosomatic pain, and chronic psychological back pain. Although we have discussed this in a previous article, we will also address, once again but briefly, the link between chronic back pain and depression. Chronic pain, in any form, can be the most insidious, debilitating and disabling of all medical conditions. In order to fully treat the condition, the underlying causes must be thoroughly explored and diagnosed. Most cases of neck pain, back pain and sciatica are or originate from an actual pathology or other physiological condition. However, psychologically based back pain is quite common and is, in fact, one of the major causes of chronic, treatment-resistant pain.
Unfortunately, when an illness is labeled as psychosomatic, it is often associated with an immediate stigma or negative perception. Very often, when a person with neck pain, back pain and/or sciatica hears the term psychosomatic, they immediately react defensively. When a condition is called psychosomatic, the connotation attached to it is that the condition is “all in the head” or somehow “imaginary”. There is even a stigma attached to mental illness, with the patient protesting, “I’m not crazy, this pain is real!” Even people close to the person, sometimes family members, will say unkind things like “I knew he was faking it” or “I knew she was just trying to get attention. I felt sorry for her!” For these and other reasons, there is considerable resistance to a psychosomatic diagnosis, often based on social and cultural grounds.
As discussed in a previous article, there is a powerful link between stress and psychosomatic illness, in this case, neck pain, back pain and/or sciatica; or chronic back pain that is resistant to treatment. In addition, the link between depression and psychosomatic illnesses, especially with age, is often very strong. People with psychosomatic illnesses may experience incredible pain or other physical manifestations or symptoms without a physical diagnosis. Paradoxically, there are several physical conditions, such as brain injuries and vitamin deficiencies, to name two, that can present profound psychological symptoms. However, it is common for many people with chronic, treatment-resistant pain, without an underlying medical diagnosis, to have a psychological or psychosomatic disorder.
Contrary to popular belief, pain that results from a psychosomatic condition, an emotional or psychological process, is actually quite real. Psychosomatic pain, in this case chronic treatment-resistant back pain, is not imaginary, it is not “in our heads”, it is not the result of a delusional or sick mind, and it is not the consequence of a mental illness. The fact is that everyone who suffers from tension headaches, ulcers, colitis, tension back pain and a myriad of other stress-related illnesses has a psychosomatic condition. Clearly, not these people are “crazy. I suppose the best way for a person to understand how real psychosomatic pain can be is to have them think back to their last tension headache and ask them one very simple question, “Was the pain real?”
Psychological back pain is simply another name for psychosomatic back pain and is sometimes called stress-induced back pain. Again, the pain associated with this condition is very real. While pain may ultimately be related to the mind-body connection, the physical expression of pain, whether it is neck pain, back pain or sciatica, can debilitate and disabling. As a result, it is often difficult, if not nearly impossible, to treat psychosomatic and treatment-resistant chronic pain if we did not effectively address the underlying condition. As one prominent evolutionary scholar has noted, we may consider psychosomatic pain an evolutionary anomaly, but it is entirely human and entirely normal. When our system, including our mind, is overloaded, it seeks to ease or eliminate the problem quickly and efficiently. Unfortunately for the patient, it does so by diverting attention from the actual cause, the real danger, and expressing it in a very uncomfortable, often intense way; and, in this case, through chronic back pain that is resistant to treatment.
Psychosomatic pain is the most frequently diagnosed and least understood form of acute and chronic back pain. It is important to note that most people with chronic treatment-resistant pain, those whose back pain is unresolved, i.e., there is no obvious diagnosis, are by definition suffering from an underlying, misdiagnosed psychological condition or disorder. Although medical schools are addressing this very important medical issue, psychosomatic illnesses have long been relegated to the back burner of medical training. As a result, physicians are simply not prepared to understand, let alone treat, this illness. As a result, they misdiagnosed many people with this “scapegoat disease”, leaving people with very real physiological, structural and medical conditions undiagnosed.
Unfortunately, while solutions exist, they are still relatively unknown. As the medical community educates itself to be better prepared to deal with this problem, we are seeing the first steps towards a holistic approach to this problem. We have discussed psychosomatic medicine for centuries; it fascinated even Sigmund Freud in his day, but it is only in the last few years that we have seen an actual movement to treat this ongoing epidemic. People with chronic pain that are resistant to treatment, especially those with a long history of unresolved and undiagnosed pain, are more likely to experience a myriad of medical problems, including ulcers, colitis and depression, to name a few. The combination of unresolved neck, back and/or sciatic pain and depression results in profound consequences for the individual, family, community, and even the state. The impact of this misunderstood and often misdiagnosed condition or set of conditions reverberates throughout the system, with consequences far beyond those of a medical nature.
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Ultimately, and until the underlying condition has been diagnosed, treated and eliminated, the symptoms must be recognized and eased. For this reason, we advise the individual to begin an extensive, individualized, medically supervised program to address both the expressed symptoms and the as yet undetermined causality. Exercise, by itself, will have a remarkable and immediate impact on most individuals. Not only will an exercise program, properly administered and supervised, do wonders to ease stress, but it will also improve self-esteem and confidence. Along with exercise, especially until the musculature adapts and adjusts to the new routine, some other steps will need to be taken. Additional treatment strategies to be implemented, besides the exercise program, should include a stretching program 2 to 3 times a day (see: “Simple and Easy Exercise Program for Sciatica Relief. Part I and Part II”). Self-education, either individually or in a group, also helps to improve understanding, self-awareness, and self-esteem. Individual or group therapy should be implemented to address the underlying issues that contribute to unresolved and/or misdiagnosed psychosomatic pain. The concert of back pain strategies will do wonders to ease symptoms, ultimately leading to resolution when used with a solid therapy program to understand the underlying stressors that have resulted in the neck, back and sciatica pain complex.
