Understanding Chronic Treatment-Resistant Pain - Psychosomatic Back Pain

Science has demonstrated that there is an incredibly powerful link between the mind and the body. In many instances, the underlying cause of neck pain, back pain and sciatica, also referred to as the back pain complex, may be psychological. Many times, when an individual is in pain and told that it may be psychological or psychosomatic, the patient immediately becomes defensive, often stating, "It is not in my mind, the pain is real!" The fact is, it is indeed very real, regardless of whether the pain is labeled as psychosomatic or not. When dealing with treatment-resistant, chronic pain the mind/body link must be explored, so it can be ruled out. In this article, we will discuss psychological pain, psychosomatic pain, and chronic psychological back pain. While discussed 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 any medical complaint. In order to fully treat the condition, underlying causality must be explored and diagnosed thoroughly. It is true that most cases of neck pain, back pain, and sciatica are or have their basis in an actual pathology or other physiological condition. However, psychological back pain is quite common and in fact is one of the primary causes of treatment-resistant chronic pain.

Unfortunately, when an illness is labeled psychosomatic there is often an immediate stigma or negative perception associated with it. Very often, when an individual suffering from neck pain, back pain and/or sciatica hears the term psychosomatic, they immediately respond defensively. When a condition is labeled as psychosomatic the connotation attached is that the condition is "all in the mind" or somehow "imaginary." There is even a mental illness stigma attached, with the patient protesting, "I am not crazy, this pain is real!" Even people close, at times members of the individual's own family, 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 reasons and others, the resistance to a psychosomatic diagnosis is considerable, often socially and culturally based.

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 treatment-resistant chronic back pain. Additionally, the link between depression and psychosomatic illness, particularly as we age, is often quite powerful. Individuals suffering from psychosomatic illness may experience incredible pain or other physical manifestations or symptoms, with no physical diagnosis. Paradoxically, there are a number of physical conditions, such as brain injuries and vitamin deficiencies just to name two, which may exhibit profound psychological symptoms. However, it is often the case that many individuals exhibiting treatment-resistant chronic pain, with no underlying medical diagnosis, may have a psychological or psychosomatic condition.

Contrary to commonly held beliefs, pain that is the result of a psychosomatic condition, of an emotional or psychological process, is actually quite real. Psychosomatic pain, in this case treatment-resistant chronic back pain, is not imaginary, it is not "in our heads," it is not the result of a delusional or a sick mind, and it is not the consequence of mental illness. The fact is that anyone suffering from tension headaches, ulcers, colitis, tension backaches, and a myriad of other stress-related illnesses has a psychosomatic condition. Clearly, all of these individuals are not "crazy." I suppose the best way for an individual to understand just how real psychosomatic pain can be is to have them think back to their last tension headache and ask a single, quite simple question: "Was the pain real?"

Psychological back pain is simply another name for psychosomatic back pain and is sometimes referred to as stress-induced back pain. Once again, pain associated with this condition is indeed very real. While the pain may ultimately be linked to the mind/body link, the physical expression of pain, whether the pain is neck pain, back pain or sciatica, may be debilitating and disabling. Consequently, dealing with psychosomatic, treatment-resistance chronic pain is often difficult, if not close to impossible, without effectively dealing with the underlying condition. As a noted evolutionary scientist once pointed out, psychosomatic pain may be considered an evolutionary anomaly but it is completely human and utterly normal. As our system, and that includes our mind, becomes overloaded, it seeks to alleviate or eliminate the problem as quickly and efficiently as possible. Unfortunately for the patient, it does this by shifting focus away from the actual cause, the real danger, expressing it in a very uncomfortable, often intense fashion; and, in this case through chronic treatment-resistant back pain.

Psychosomatic pain is the most frequently diagnosed and least understood form of both acute and chronic back pain. Significantly, most treatment-resistant chronic back pain sufferers, those with unresolved back pain, meaning that there is no clear diagnosis, by definition suffer from an underlying and misdiagnosed psychological ailment or condition. While medical schools are beginning to address this very significant medical issue, psychosomatic illness has long been relegated to the back burner of medical education. Consequently, medical practitioners are simply not prepared for or able to understand, much less treat, this condition. As a result, many individuals are misdiagnosed with this "scapegoat condition," leaving individuals with very real physiological, structural, and medical conditions undiagnosed.

Unfortunately, while solutions are available, they are still relatively unknown. As the medical community begins to educate itself, so they can be better prepared to deal with this condition, we are beginning to see the first steps towards a holistic approach to this problem. Psychosomatic medicine has been talked about for centuries, even Sigmund Freud was fascinated by it in his time, yet it is only in the last few years that we see a real movement to deal with this ongoing epidemic. Treatment-resistance chronic pain sufferers, particularly those individuals with an extended history of unresolved and undiagnosed pain, are most likely to exhibit a myriad of medical complaints to include ulcers, colitis, and depression, just to name a few. The combination of unresolved neck pain, back pain and/or sciatica and depression leads to profound consequences for the individual, the family, the community, and even the state. The impact of this poorly understood and often misdiagnosed condition or set of conditions ripples throughout the system with consequences far beyond those of a medical nature.

Ultimately, and until such time as the underlying condition has been diagnosed, treated, and eliminated, symptoms must be recognized and alleviated. For this reason, it is advisable for the individual to begin a wide-ranging, individualized, and medically supervised program to deal with both symptoms expressed and causality yet undetermined. Exercise, in and of itself, will have a remarkable and immediate impact on most individuals. Not only will an exercise program, properly administered and supervised, do wonders to alleviate stress, it will also serve to improve self-esteem and self-confidence. With exercise, particularly until the musculature adapts and adjusts to the new routine, certain other measures will need to be taken. The additional treatment strategies to be initiated, along with the exercise program, should include a stretching program, 2 to 3 times a day (see: "Simple and Easy Program of Exercise for Sciatica Relief... Part I & Part II"). Self-education, both individually and in a group setting, will also enhance understanding, self-knowledge, and self-esteem. Most importantly, either individual or group therapy should be initiated in order to comes to grips with the underlying issues contributing to the unresolved and/or misdiagnosed psychosomatic pain condition. The concert of bad back strategies will do wonders to alleviate symptoms, ultimately leading to a resolution when used along side of a solid therapy program to understand underlying stressors which resulted in the back pain complex of neck pain, back pain, and sciatica.
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John P. Zajaros, Sr., The Bad Back Guy

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