'The Only Thing We Have to Fear' is a Good Axiom for Back Pain
(HealthDay News) – There are times when the fear of what a disease or condition will do to you eclipses the actual experience.
And for people who have had back pain injuries, the very idea of movement can evoke a tremendous amount of fear.
No one knows how many Americans with lower back pain become afraid of making any sort of movement that might make their pain worse. However, psychologists have given the condition a name: kinesiophobia.
Slowly reintroducing someone with back pain to normal movement seems to work the best, just as gradual exposure to spiders can cure someone of arachnophobia, says Johan W.S. Vlaeyen, professor of behavioral medicine at Maastricht University in the Netherlands .
Humans have a built-in "fear network," he says, and it sometimes requires reprogramming. "Fear reduction only occurs when the fear network is activated, and new information is provided. The most convincing information is personal experience," he explains.
"There is a tendency to stay as still as possible to avoid any more pain," Vlaeyen explains, and those who are afraid of moving become "hyper-vigilant," watching their bodies carefully for any sign of problems.
"They continuously scan their body for pain and dangerous sensations," he says. "The fearful are better body scanners than their low-fear counterparts."
However, inactivity can actually make a person's pain worse as muscles atrophy and fail to tolerate simple tasks, says Dr. Bill McCarberg, former director of the chronic pain management program for the Kaiser Permanente health plan in San Diego . "Muscles can have trouble reactivating to handle normal kinds of events like getting out of bed or standing in the grocery store, bending over and putting shoes and socks on."
McCarberg says the wide majority of patients don't have phobias but simply want to avoid activity that makes them hurt. "You need to keep the person as active as you can, despite pain," he says.
In cases where there is a phobia, the best approach to change a person's attitudes is exposure to movement, Vlaeyen says. Reassurance is least likely to make any sort of difference, and education isn't always effective.
Instead, patients must actually make the movements they're afraid of, he says.
During treatment, patients look at pictures and describe which activities frighten them the most. "Then they go through experiments to see if these certain activities lead to injury," he explains.
The therapy seems to work, he says. "Their fear levels drop drastically."
On the Web
For more information about lower back pain, see the section on this subject at the American Academy of Orthopaedic Surgeons.
SOURCES:
Johan W.S. Vlaeyen, PhD, professor, behavioral medicine, Maastricht University Medical Center, Netherlands and p rofessor of behavioral medicine, department of psychology, University of Leuven, Belgium; Bill McCarberg, M.D., former director, chronic pain management program, Kaiser Permanente health plan and assistant clinical professor, (voluntary) University of California, San Diego
Author:
Randy Dotinga, HealthDay reporter
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