Worrying about your future can make chronic back pain worse- catastrophising

When you have got back pain its very easy to worry that there is something seriously wrong. In western cultures we are very anxious about the human spine, we think it is weak and vulnerable. This can lead to a common problem called catastrophising. This means worrying that something terrible has happened or that dreadful things will happen in the future as a result of having a back problem. Often people develop very real anxiety about not being able to work in the future, some even fear that they will end up in a wheelchair or be able to care for themselves.

This is often made worse by the use of medical language.

Most of us working in health care would agree that we share and understand a language that is confusing and complicated to many people.  

There are times when medical words can seem very frightening. For example lumbar spondylosis simply means X-ray findings of changes in the spine which are common and often occur as we age. Most people have these changes as they age but I often meet people who are really worried about this as it sounds so serious.

Many people I meet have heard or been told things about their back that has worried them.

• They may have been told they have a ‘slipped disc’,
• ‘sciatica’,
• a ‘trapped nerve’,
• ‘degenerative disc disease’ or
• ‘wear and tear’ of the spine.

You may have been told this yourself. If you don’t understand what these terms really mean it can cause you to feel nervous, upset and fearful of movement. This can make your back pain more of a problem.
This confusion and fear can also lead to catastrophising about the future. If this sort of misunderstanding is combined with beliefs that back pain is a really serious problem then it can lead to lots of very unhelpful behaviours such as fear avoidance and withdrawal from work and social activities. I have met many, many people with simple lower back pain who hold grave fears that they will one day be in a wheelchair or may never work again.

Case Study

Shirley was a fifty four year old woman who had had back pain on and off her whole life but recently it had become much worse and hadn’t eased off like it usually did. She had been forced to stop work because of the pain and had become increasingly housebound. She had sought help from her doctor who had referred her for physiotherapy.

When I met her she had been off work for 3 months and rarely left the house. Everything she did was painful and she was very fearful that most daily activities were worsening her problem.

I asked her what she thought the problem was. She said she knew exactly what it was as the doctor had told her and that it had been backed up by an X-Ray. She went on to tell me that her mother had had the same problem and had ended up in a wheelchair and had been totally unable to care for herself, she had had to move into a nursing home, had developed lots of breathing problems and eventually died.

I was completely horrified at this story, I asked her to tell me more about her mothers condition. Shirley told me her mother had ankylosing spondylitis and that the doctor had said she had that too. I realised straight away what had happened. Shirley’s doctor had in fact told her she had lumbar spondylosis which is a normal part of aging. Shirley had assumed it was the same thing as the words were similar. But they are very different.

(By the way Ankylosing Spondylitis is managed much better these days than in Shirley’s mother’s time – there is no need to become disabled even with that condition)

I explained the difference between the two things and reassured her that that her diagnosis was not the same thing at all. I have rarely seen someone so relieved.  She became less anxious about the future, less fearful of movement and started a programme of paced exercises. She began to get back in control of her back problem.

A simple thing like this can make a huge difference.I suggest you talk to your health care provider about your worries and fears.

• If you have concerns about your diagnosis
• think you need help with psychosocial care
• if you don’t really understand your back pain
• or you are worried about the future

Lower Back Pain Toolkit Home Page

Read more about Psychosocial Yellow Flags

Back Pain - Fear Avoidance

Differing Diagnosis

02-Mar-2015