Lower back pain affects over 80% of people at some point in their lives. While most instances are acute, meaning they resolve within 3-6 months, 5-10% of cases become chronic. Diagnosing back pain is one of the biggest challenges for medical professionals; prevention is always the best option.

How can you prevent chronic pain when you do not always know what causes it? One approach is to understand the risk factors associated with the progress of acute to chronic pain. Some of the best predictors are psychological and emotional states surrounding pain, along with the fear-avoidance behaviors they cause.

Psychological and Emotional States

Pain is often not exclusively a physical phenomenon; experiencing pain takes a toll on our emotional and psychological lives. The reason for this is likely twofold: 1) the same neurotransmitters and areas of the brain are involved in processing both physical and emotional pain and 2) being in pain affects our quality of life by limiting our activities and simply placing us in a persistent unpleasant physical state. While it is normal to experience non-physical reactions to pain, the amount to which these reactions occurs changes from person to person and can actually have a determining role in the prognosis of pain recovery.

Numerous studies have been connected to assess the power of our psychological and emotional states to influence our physical health. One, entitled “Pain Catastrophizing and Kinesiophobia: Predictors of Chronic Low Back Pain,” assessed 1,571 Dutch participants. Catastrophizing is defined as the psychological state in which one one thinks something is far worse than it really is. Kinesiophobia is a fear of movement, often brought on by pain. These two experiences were assessed using questions in which respondents answered questions that described their reactions and feelings towards pain on a scale of 1-5.

The results: People with high catastrophizing and kinesiophobia scores were 1.5-1.7 times more likely to have lower back pain and limitation at the six month follow-up than those with lower scores.

Catastrophizing and kinesiology can be expected to co-exist; the idea that pain is worse than it is causes fear of activity that could cause pain. Back pain can be triggered by near any motion and, therefore, those with overly negative reactions to pain may cease most activity. Physical deconditioning, including loss of muscle strength and reduced cardiovascular function, can cause pain to persist and increase. Psychological state and actual sensation of pain may also be connected due to the sharing of neurotransmitters and brain areas mentioned above.


It is possible to disrupt this pain cycle. The first step is to be aware that psychological and physical states are linked.

Next, to prevent counterproductive kinesiophobia, education is needed. If the exact cause of your pain is unknown, it can be difficult to determine what activities are safe to perform. Any good physical therapist or doctor will tell you, however, that activity is needed to recover from and prevent future back pain. Exercise therapy is one of the most standard treatments for all types of back pain. When the cause is unknown, basic core exercises are generally recommended to strengthen your back's support system. Of course, if an exercise hurts, do not do it. The array of balanced, integrated core exercises that exist should ensure that there are options for you. Cardiovascular exercise should be a component of your exercise therapy as well. For those with severe back pain, exercising in water is the best option.

One of the best was to prevent negative thought patterns like catastrophizing is to acknowledge and address the psychological implications of pain early on. Being proactive about treatment will help you feel more in control of your pain. Find support from others in the same situation as you and research your pain to keep up-to-date on possible causes and treatments. If you are struggling to keep a realistic attitude toward your pain, cognitive behavioral therapy can help you replace negative thought patterns with healthier ones. Above all, do not consider psychological symptoms as a personal weakness to be hidden, denied or ashamed of. They are valid symptoms of your pain condition that require just as much attention as the pain itself.

More on the above study can be found at http://aje.oxfordjournals.org/content/156/11/1028.full . Keeping yourself informed of chronic pain risk factors can help prevent pain in the future.