Lower back problems are very common and pose a significant problem because pain can be experienced in one situation and not another. Many people in their 40’s and older have desiccation of the intervertebral discs, disc bulging and even small annular tears in the disc. Research clearly demonstrates that the level of degeneration is not related to the pain experience because there are individuals with relatively severe degenerative conditions affecting their spine but who report no pain and who continue to have the ability to perform a wide range of movements and activities without restriction.
This results in a higher proportion of patients suffering back pain being told that there is nothing wrong with them, that it is “in their head” and feeling that they are effectively being accused of putting it all on. In any counselling situation it becomes especially important to avoid being drawn into this kind of conflict situation. It is important to combine a counselling approach that focuses on distraction from pain, reducing pain focus and movement fear with an approach that seeks to improve quality of life. Activity is very important and this means they need to learn how to pace themselves and create a balanced life. An understanding of the pain process and some work to reduce frustration and irritability while encouraging an increase in social and other activities is often important. It is crucial to combine this approach with good physiotherapy that can strengthen the paraspinals, the multifidus and abdominal muscles.
Our clinicians develop a program that incorporates a balance between the physical and the psycho-physiological. Many patients are initially uncertain about how a psycho-physiological approach can prove helpful arguing that the pain is in their body and not in their head.
The following link to the Family Doctor web page on lower back pain provides some helpful information: http://familydoctor.org/x2563.xml