Working with Pain

Back pain affects nearly all of us one way or another, whether it is a sudden flare-up which stops us in our tracks or having to deal with persistent pain which prevents us doing the things that make us tick. It can often vary from day to day, making it difficult to plan things. Most of us will know of friends or relatives who struggle to live an active life due to back pain, and it is common to feel helpless in being able to assist them back to the life they had before. But the way we help people recover from back pain is changing, thanks to a large body of research and which has helped to re-write the rules on persistent back pain.

This approach acknowledges that biological, psychological, and social factors can all play a role in the experience of back pain. You never get one without the others; they always link together. People with back pain are much more likely to benefit from treatment if we consider all three of these factors in tandem. Until fairly recently back pain treatment did not focus on such a broad view, but it is now widely accepted that there is an association between psychological, biological, and social factors whenever pain is experienced

From a biological perspective we know that many changes occur in our body when we experience back pain: involving our central nervous system (that is the brain, spinal cord and autonomic part of the nervous system), our endocrine (hormones) system, our immune system and our musculoskeletal system (our muscles, tendons and joints). These biological changes become more pronounced as back pain persists and play an important role in maintaining back pain and poor function, long after we had expected to recover. We still do not fully understand all the myriad of biological changes that occur when we experience back pain, but researchers continue to reveal new and exciting theories relating to how these changes link to the pain experience. Understanding this will help you to recover.

From a psychological perspective, we know that when people experience an episode of low back pain, there are different psychological responses. For example, some people become fearful of moving, and worry they might cause more damage to their back. Some people avoid activity because they fear they may get a further disabling flare-up of back pain if they push their activity too much. These are normal and logical psychological responses to an episode of low back pain; but if they persist and are left unchecked will contribute to persisting back pain and poor function. Some people become overwhelmed with negative thoughts relating to their bad back and develop low mood or anxiety linked to their back pain. They then get stuck in a vicious cycle of fear, avoidance, negativity which they struggle to recover from. It can be very difficult to get out of this vicious cycle on your own. Understanding this will help you to recover.

From a social perspective, we know that the circumstances in which you live, and work can influence your recovery. If people around you, including friends, family, work colleagues, health professional or bosses incorrectly view your back pain as a problem which needs protecting or as something that will end your career, it will have a significant negative impact on your ability to recover. We may read things in the media or on-line about back pain which influences what we do about it, but that information may be wrong and can help to maintain our back pain and poor function, rather than help us to recover. Or you may be in a medical system with long waiting lists, and do not get the chance to get the right advice about how to recover from back pain until several months pass. At this point, many biological and psychological changes may have taken hold and you find yourself in a cycle of persisting pain and poor function. Understanding how this links to your back pain will help you to recover

So, to be able to effectively help yourself restore function and quality of life when back pain persists, it is really helpful to understand how these three systems are combining together to maintain your pain problem. 

WMUK are at the forefront of helping to get this new understanding of pain out to both individuals that may be experiencing pain as well as professional’s working to help people with persistent pain problems.

Training for Health Care Professionals:

Understanding how to successfully assess, treat and manage employees with back pain should be a core skill for OH professionals, as back pain is the leading cause of long term disability and work loss in the UK, posing a huge burden to the individual, industry and the economy. Central to this understanding is ensuring that OH professionals develop a thorough knowledge of the role of psychological factors in back pain. 

Emerging evidence over the past few years has helped us to understand back pain from a much broader perspective, and we now acknowledge that psychological factors can play an important role in both short and long-term workplace absence due to back pain. By learning how to assess these factors, we are able to identify aspects of employees back pain experience that may be holding up their recovery and preventing them getting back to, or remaining at work. This type of approach, using cognitive behavioural principles is now recommended in clinical guidelines for the treatment of back pain, and the research base for this approach is substantial, with studies demonstrating improved outcomes when compared to usual care.

We are excited to have teamed up again with The@Work Partnership in developing a training programme that has been launched since 2017. This one day workshop looks at how to assess and treat psychological obstacles to recovery in back pain to improve consultations and employee outcomes.