There's more to a bad back than a damaged spine, new research says
A study into the causes of back pain has found that depression and anxiety play a greater role in this poorly understood condition than first thought.
Researchers from Deakin University's Institute for Physical Activity and Nutrition (IPAN) and Monash University found people with mental health issues were more likely to experience back pain, suggesting that clinicians need to place greater emphasis on overall wellbeing when treating back ailments.
IPAN PhD candidate Scott Tagliaferri said researchers set out to compare the differences between mental wellbeing, spinal tissue and nervous system health among people with back pain and those living pain free.
"We found mental wellbeing was worse for people with back pain than those without pain but, more significantly, the impact of mental wellbeing was greater than spinal tissue damage or nervous system changes on those experiencing pain," Mr Tagliaferri said.
"This is not to say that pain is "all in someone’s head" - pain is always real - but we now have evidence of the important role that emotions and beliefs play in back pain."
Mr Tagliaferri said the findings are a potential game-changer in the clinical care of back pain as they provide the first clear evidence that mental wellbeing is a significant factor in the cause and health impacts of back pain.
"The research is telling us that more attention needs to be paid to the mental well-being of people with back pain and referral to specialist mental health services may be an important avenue of treatment," Mr Tagliaferri said.
In a meta-analysis, researchers pooled data from nearly 3000 people with and without back pain in more than 30 studies that examined at least two of spine tissues, brain changes and/or psychological factors.
"We wanted to know whether damage in the spine (for example, degenerative discs or weak muscles) or changes inside the brain that make the person more sensitive to persistent pain or psychological factors (for example, depression or anxiety) are more important for back pain," Mr Tagliaferri said.
"The main finding was that psychological factors were more prominent in people with back pain than, for example, spine or nerve damage.
"People should understand that back pain is not just the result of damage to their spine. For example, more than 50 per cent of 50-year-olds, who do not have back pain, have degenerative spinal changes.
"Even though those with these changes are more likely to have pain, other factors, such as their psychosocial health and changes within the nervous system may also be important and need to be considered as part of treatment."
"This may help explain why some people take much longer to recover, or never fully recover, following treatment for back pain because these other factors are not being addressed."