Dismissing the Psychological Contribution to Spinal Pain

Another fallacy (which is currently being touted in the back pain treatment circles usually accompanying the mischaracterization of a person in legitimate pain as being poorly motivated) is that when people don't get better in keeping with the averages, they have a good probability of having a psychological component to their back pain which is interfering with the therapeutic process. This causes me to advise: When your doctor drags out a psychologist or psychiatrist to participate in the management of your back pain yet you know you are in real pain and that it is the pain itself causing the depression, anxiety, or hopelessness, it is time to re-evaluate the successfulness of your current therapeutic regimen and the wisdom of your physician or his HMO. You can usually spot this coming when the doctor begins addressing the "lack of progress" in your treatment and starts talking about the potential for "the mind to play a role in the perception of pain." At that point, you should carefully read this website if only to reassure yourself that you are not crazy; and you may legitimately conclude that your medical provider has nothing more to offer you.

These supplemental diagnoses range from depression to malingering or "secondary gain." Now, I sincerely believe that many humans are prone to these problems; but not nearly with the frequency for which they are evoked as an explanation for failing to markedly improve. In this day-and-age of workman's compensation and employer-paid benefits, a designation of having failed to improve seems to be equated with nothing less than returning to full physical labor employment.

When attending back pain conferences wherein a major portion of the program focuses upon the psychological and psychiatric components of chronic back pain, I actually get angry when they "put the cart before the horse" by theorizing that the problem is not so much the pain but the way in which the patient perceives or deals with the pain. The implication is that there is some inherent fault in those with chronically severe, unremitting, back pain who aren' t getting better as readily as the statistics would predict. One noisome piece of advice recently published suggests that the doctor approach the problem by a statement like this: "I understand you are in pain, many people have chronic back pain; but what I would like to discuss is the manner in which you are not able to deal with the pain as they do." This implies that if they had improved coping skills, they would not have as severe a pain problem. Having taken countless people out of pain who have suffered from unaddressed mechanical spinal pain for years, I have become convinced that evoking a psychological cause for the pain evidences more the care-giver's lack of ability rather than the patient's lack of psychological management skills.

Certainly, after suffering intractable back pain a person will most likely become anxious, depressed, and often temperamentally disappointed when met with unconvincing or contradictory opinions or when the same unhelpful pablum that they have heard before is regurgitated by yet another "expert specialist." The minute the doctor senses this attitude, he can defensively evoke the psychological component and allege that it is a mental problem that is preventing the patient from getting better. In this way, they place the "cart" way before the "horse" and attempt to convince the disability evaluator, your employer, or even yourself that your mind is what is the matter--not your back. At least one premise that this website operates upon is that in the overwhelming majority of instances the psychological component is a consequence of the pain, not the source. For that reassurance, I hope the reader will be at least grateful.

I have come to the above conclusions having experienced first-hand the excruciating, frightening and confusing pain of a Lumbar disc herniation. Within several days of that experience's onset, I guarantee, I was not willing to go out and exercise because, by then, the pain had subsided only just enough to walk around without assistance. I would reject now, as I would have then, the proposal that I begin exercising the back muscles so soon after the injury as one contemporary philosophy advocates.

I am convinced that this rejection would have been judiciously noted in my medical record (as I have seen so noted in my patients' records) and used later to argue the existence of a lack of motivation if, or better, when the treatment failed. In my case, despite being a resident physician in a teaching hospital with orthopedic, physical medicine, and rehabilitation teaching programs, the treatment was nevertheless benign neglect based upon the misleadingly grand assumption that 70% of back injuries recover in 2-3 weeks and 90% of back injuries resolve within six weeks no matter what is done. By doing nothing, at least they couldn't be accused of making the problem worse. However, if I knew, then, what I know now, I have no doubt that I would have been able to get out of pain immediately, and could have prevented a majority of the problems that came later due to ignorance.

Hopefully, with the intention of eliciting a sigh of relief in the reader, for the most part, the movements advocated in The O'Connor Technique (tm) are not true exercises. So, I refer to them as MANEUVERS. Exercises are designed to build, strengthen, or increase the endurance of muscles. The movements described in this treatise are intended to centralize displaced disc material. Once the disc material is centered, it is not absolutely necessary to persist in such movements. In fact, if these MANEUVERS are over-done, the risk of irritating tissues and inducing inflammation could be increased.

For instance, when the back is put into hyperextension and moved excessively or repeatedly as in a push-up type McKenzie exercise, the joint surfaces of the vertebral bones are exposed to excess wear to which they are not accustomed. This can cause arthritis. Additionally, the edges of the vertebral bodies (that portion that constitutes the outer circumference of the vertebral body) nearly rub bone on bone together especially in the ageing back with osteophytes (bone spurs) and disc height loss due to degeneration. Ordinarily these are not necessarily painful unless arthritis is present. However, when they are caused to rub together continuously, such as in the case of repeated exercise, an inflammatory situation can be produced similar to any activity in which joints are repeatedly over-stressed or pressured in the extreme ranges of their motion.

The beauty of The O'Connor Technique (tm) MANEUVERS is that they need only be accomplished when disc material is de-centralized and in the presence of pain. When a disc is de-centralized, "out," or herniated, it can be felt to be so upon self-examination (you will learn how to do this in the Chapter on DIAGNOSING DISC DISEASE); and only then need the movements be practiced.

Article Contents:
You are not alone
The Pain
Contemporary Perspective on Back Pain
Historical Perspective of Back Pain
Science and Art
Alternative Therapeutic Modalities
Back Surgery
Comparative Programs
Not an Excercise Program
Dismissing the "Psychological" Contribution To Spinal Pain
Getting Better as a Process
Become your own Chiropractor
Hope

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