Back pain and psychological triggers
Back pain doesn’t always only have a physical cause. The mind can also play a role in irritating body and nerves. Stress related to work or family creates emotional blockages that psychotherapy can address.
Transcript
00:00 Melanie Lückenhoff used to run to catch the bus, despite her back pain.
00:05 She'd get stressed out and increasingly tense.
00:08 Luckily, all that's now in the past, after a lot of hard work on her part.
00:13 I feel more confident, more stable.
00:16 I'm not pain-free yet, but I also know what's good for me now,
00:20 physically as well as mentally.
00:24 It started with severe back pain over a year ago.
00:28 After an MRI, she was diagnosed with a displaced vertebra.
00:33 Her doctor advised her to have surgery, a procedure involving spinal fusion.
00:37 She was 47.
00:39 I was horrified.
00:42 It was like there's no escape from back pain except through surgery.
00:46 But I didn't want to believe that.
00:49 I felt I was too young.
00:53 She decided to seek a second opinion,
00:56 hoping to find another way to relieve her chronic back pain.
01:01 Orthopedic specialist Carsten Wieschat gave her a thorough examination
01:06 and looked at her MRI scan.
01:08 He also diagnosed a displaced vertebra.
01:11 But his experience indicated that wasn't the main cause of the back pain.
01:16 In well over 50% of all cases,
01:19 the structural changes that you see on the scans are not the main cause of the symptoms.
01:23 Patients worry, of course.
01:26 They can see the changes on the MRI or other types of scan.
01:29 But the cause of the pain is often quite different.
01:32 That's where the psychological element plays a leading role.
01:39 Psychological?
01:41 Melanie Lückenhoff had thought she would have to do physiotherapy,
01:44 exercise more or get massages.
01:47 She was a little taken aback.
01:49 For me, it wasn't about my mind.
01:51 It was physical. It was my back.
01:53 I wouldn't have thought of psychotherapy.
01:58 That reaction to the connection between mind and back pain
02:01 is something Anna-Katharina Döpfer comes across frequently.
02:05 In her experience, people tend to focus too much on physical factors.
02:10 Humans aren't machines.
02:12 We don't function on a cogwheel-by-cogwheel basis.
02:15 Many factors influence us, including the fact we have a head, a heart and emotions.
02:20 They all play a role and have to be taken into account when assessing pain,
02:24 because pain is complex.
02:27 Pain can also be caused by psychological stress.
02:30 The body is put on alert.
02:32 Muscles tense up.
02:34 Nerves are stimulated.
02:36 Pain is an early warning system.
02:39 But the nervous system can become super sensitive.
02:42 Pain then loses its warning function.
02:45 Nerves can go rogue, constantly transmitting pain signals.
02:49 The body remains in a state of alarm.
02:52 The brain becomes fixated and a pain memory develops.
02:56 The result is a vicious circle.
02:58 Stress causes pain and the pain causes even more stress.
03:02 That leads to a signaling cascade, so the pain is perceived with ever more intensity.
03:08 The patient grows anxious and avoids the pain,
03:10 and avoidance tends to accelerate the process of the pain turning chronic.
03:16 But how do you escape the vicious circle?
03:19 What's called multimodal pain management can be a solution.
03:23 It involves doctors, psychotherapists and physiotherapists working closely together
03:28 and developing a treatment plan in three areas.
03:31 Medical treatment, physiotherapy and psychotherapy.
03:36 And the latter plays a key role.
03:39 Psychologist Katrin Schlegel knows how low back pain impacts on the mind.
03:47 We know that after about three months, the brain literally starts to learn pain.
03:52 The brain becomes sensitive and labels certain movements as the cause of pain and potentially dangerous.
03:58 Certain thoughts encourage us to avoid doing things so we don't do them in the future.
04:04 Scientific studies show that chronic low back pain can also be treated with psychotherapy.
04:11 In one meta-analysis, researchers evaluated almost 100 studies with over 13,000 participants
04:18 and found behavioral therapy to be the most successful treatment.
04:24 Physiotherapy combined with psychotherapy achieves the best results.
04:30 Melanie Lückenhoff is trying that approach.
04:33 She wants to use psychotherapy to get to the emotional and psychological roots of the problem.
04:39 In therapy, she realizes how much pain has dominated her life.
04:44 The three practitioners consult frequently during the multimodal therapy, which lasts about three to four weeks here.
04:50 Progress is often surprisingly fast.
04:54 Patients often realize after just a few days that if they focus on reducing stress
05:00 and what links stress with pain, then they can also reduce pain by reducing stress.
05:07 Dörte Bader began multimodal pain management two weeks ago.
05:12 The death of her parents and loneliness during the COVID-19 pandemic put her under a lot of strain.
05:18 She's had lower back pain for years.
05:21 When I'm stressed out or when there's an acute problem, I can't switch off.
05:26 Then I can't sleep well, and the next day it gets off to an even worse start
05:30 because I'm exhausted and my back hurts even more.
05:37 Fear of pain is one aspect. Fear of movement is another.
05:42 Physiotherapist Tim Freitag first tries to discover where the 58-year-old's physical and mental blocks are.
05:50 Often people are afraid of causing more damage, like they fear a disc could slip or a nerve could get pinched.
05:56 It's our job to dismantle such thought patterns.
06:00 With physiotherapy, daily for several hours. Not passive, but active circuit training.
06:09 And off you go.
06:11 Movements are geared to everyday life. Sweeping, clearing out shelves, painting walls, trying out what works and what doesn't.
06:20 Here it's okay, but lower down it's really bad, right here.
06:24 Building up muscle, regaining confidence.
06:29 Practicing how to consciously face the pain.
06:33 Some people dodge tasks, others overexert themselves.
06:37 Ultimately the key thing is confronting people with what they can't do anymore and don't like doing anymore
06:44 and getting them to sense how much does it take to get better in this area, in this everyday activity.
06:51 Dörte Bader also takes part in group psychotherapy sessions.
06:55 She's started to understand more about what her back pain has to do with her mind and emotions.
07:01 I know it's allowed to hurt, but this training helps me to attenuate that pain and I can handle it better.
07:09 That's also the case with Melanie Lückenhoff.
07:12 She doesn't let her back stress her out anymore. Now she is in control of the pain, not the other way around.
07:19 It's given me a new way to grow more relaxed and approach things differently.