Thanks again for joining us on this journey of 5 blog posts regarding low back pain. Once more, if you haven’t read our previous posts please do so here, here, here and here as these will really set the scene for what we are discussing today.
When questioned in the clinic, most people look for a specific incident that led to their onset of low back pain. Lots of people that we see will try to attribute their pain to a specific event such as bending, lifting or strenuous activity. But when we dig a little deeper it is often the case that this link between a specific event and pain is quite weak. What I mean by this is that someone will typically say: “well it could have been when I was moving plant pots in the garden last Saturday, but my pain only really started this Friday- but it must have been the plant pots because I haven’t done anything else to trigger it”. Here we have a situation where 6 days has passed so the plausibility that moving plant pots has CAUSED the low back pain is quite small. But it is human nature to want to make sense of a situation so we grasp onto something that seems to fit our belief system. And typically, moving heavy plant pots around the garden would be something that we would associate with low back pain. However, please head back and read our blog here on the poor link between bending, lifting and pain. So, in this specific case we might be left in a situation where causation can’t be established but lifting plant pots may have CONTRIBUTED to this persons pain- that I cannot refute.
But have you ever stopped to consider what else might contribute to a pain experience? Do you ever sometimes get low back pain, or any pain for that matter, that you simply can’t put an explanation to? I know in the past it has happened to me. It has certainly happened to my family members. In fact, it has probably been happening to us all for a very long time. Fortunately, in recent times research into pain has progressed at a rapid rate and there are some current truths that we need to discuss:
Pain is not an accurate measure of tissue damage.
In fact, tissue damage is not necessary for someone to experience pain.
In other words, pain can exist in the absence of any tissue damage whatsoever.
Pain can also exist when tissue damage occurs.
Sometimes pain will not be present despite tissue damage having occurred.
Take a second to read those statements again. This is not easy to follow because it pretty much challenges most people’s beliefs about what pain is and isn’t, but I’d like to share a few examples with you that might help clear things up.
Pain is not an accurate measure of tissue damage:
Surely a gunshot wound would produce an awful lot of pain? Military veterans often suffered horrendous injuries in the line of fire. Examples can include people being shot and reporting no or very little pain at the time of the incident.
How about when you have played sport and two days later you realise you have a large bruise on your leg which has become painful? Why did you not notice this when it happened- or even in the cool down, or even for the next 24 hours? Tissue damage was present as evidenced by the bruise- but no pain was felt until 48 hours later.
Tissue damage is not necessary for someone to experience pain:
For this we turn our attention to trickery and ethically questionable research! So, someone volunteers for an experiment where they sit and a large device is placed over their head- think a 1960’s hair salon. There is an experimenter in a white coat turning dial which is incrementally labelled as being more and more dangerous. The person in the chair reports increasing symptoms of headaches as the dial is turned. But guess what- the machine is not plugged in. So, no tissue damage at all yet increasing pain is still reported.
Pain with tissue damage:
We can all relate to a few examples here: a rolled ankle, sunburn, a dislocated finger or a simple paper cut. However, isn’t it interesting that people will still report varying levels of pain despite having very similar amounts of tissue damage or injury. We could use all of these examples as pain not being an accurate measure of tissue damage as well.
“You know in the movies where a gun goes off and there’s a sudden look of shock on the victim’s face before he looks at the wound? That’s very accurate. I did not feel any pain or anything. I heard the gunshot and felt a tight pressure in my arm. I looked and saw the wound and how much blood I was losing, and the next thing I know I’m in the hospital” Source here
Now, if we can get a good understanding that pain is not a good predictor of tissue damage it begs the question of why does it vary so much from one situation to the next or one person to the next? How can someone suffer a gunshot wound and report no pain, but a papercut can feel like the worst pain ever? Or how about a more extreme example of using acupuncture instead of a general anaesthetic for surgery?
Quite simply, anything that affects the individual can affect their pain experience. We are shaped genetically and through our upbringing- our belief systems, culture, education and backgrounds all influence how we view the world and make sense of certain situations and can also influence our pain.
Stress, depression and anxiety are all perceived as psychological events but in fact have large biological effects on the body. Many of the chemicals, hormones and neurotransmitters that we produce when stressed, depressed or anxious will facilitate the production of pain.
Worry, lack of sleep, catastrophising (this is the way we think that the worse is going to happen) can also be pain promoting.
So essentially, any factor that affects you as an individual can have an influence on your pain. For some people stress may be a large contributor. But others suffering with similar levels of stress might find that their pain experience is not influenced.
And don’t get me wrong for some people the main contributor might be biomechanics, lifting or the way we move. But by exploring different aspects of your life it may well be that there are other factors that influence your pain, and this is exciting. In fact, it’s really exciting because this gives us a huge scope for treatment. It allows us to focus on the things that matter to you and allows us to get the best possible outcome. There would be nothing worse than focussing on lifting technique when it was depression that was driving a pain experience. Conversely, seeing a psychologist isn’t going to do a lot for your muscle strength. So, getting a great assessment and really getting down to what the contributors are to your episode of low back pain (or any pain for that matter) is going to help guide treatment and get a great outcome.
As a final thought, try to think of pain as a similar experience to humour or laughter. What one person finds funny, another may not. Equally, a joke out of context might not be perceived as funny but if placed in a different context can have 3 thousand people laughing. Your demographics, upbringing and beliefs will influence what you do and don’t find funny as will your current mood.
So next time you experience low back pain and you are trying to think back to a particular cause, cast your net a little bit wider. Consider some of the factors mentioned here. And if you’re unsure get some guidance from a great health care provider who is willing to explore some of these areas with you.