Treatments for stress related back pain
Just as there are a variety of theories about how stress
and other emotional or psychological factors can cause
back pain, there are a variety of treatment approaches.
The following outlines two approaches:
Dr. Sarno’s approach to treatment of chronic pain
Dr. Sarno’s approach to patients with stress
related back pain or TMS, is one of emphasizing the
psychological and emotional factors as causative and
reassuring the patient as to t he importance of a return
to full physical functioning.
Dr. Sarno’s approach focuses almost entirely on
the repressed emotions of anger or rage as the causative
factors for the back pain. Once the diagnosis of TMS
is made it is strongly recommended to the patient to
"think psychological, not physical" when the
pain occurs. In addition, this treatment approach is
generally limited to accepting the stress related back
pain for what it is (through a series of educational
lectures) and/or getting psychotherapy to address the
unconscious issues.
This theory and approach is very different than the
way most physicians manage patients with these back
symptoms.
Multi-disciplinary treatment of stress related back
pain
The multi-disciplinary (or integrated) approach
defines and treats stress related back pain in somewhat
broader terms than Dr. Sarno’s concept of TMS.
With the multi-disciplinary approach, the health care
professionals do not always see the well-defined personality
characteristics that Dr. Sarno discusses and do not
focus on unconscious anger as the focal psychological
issue.
The multi-disciplinary approach to treating stress
related back pain includes evaluation of physical,
emotional, cognitive and environmental factors in
all types of back pain problems and develops treatments
for each aspect. Thus, the multi-disciplinary formulation
will look at the relative contribution of the following
factors:
-
Physical—including de-conditioned and weak
muscles, nerve irritation, etc.
-
Emotional—including depression, anxiety,
anger, etc.
-
Cognitive—such as negative thoughts, pessimism,
hopelessness, etc.
-
Environmental—such as loss of job, financial
problems, etc
This approach then develops a treatment program based
upon how much each factor is thought to be influencing
the pain. A multi-disciplinary program may include such
treatments as:
-
Treating the physical factors through re-activation
oriented physical therapy and/or pain medications
-
Treating the physical and emotional factors through
appropriate medications (often including anti-depressants
or muscle relaxants)
-
Treating the emotional and cognitive factors through
psychological pain management techniques and biofeedback
-
Treating the environmental factors through counseling
or therapy
The idea of multidisciplinary treatment of back pain
has been around for at least 25 years. It has been shown
to be quite successful; although, the key factor in
treatment outcome is the motivation of the patient to
complete a rehabilitation approach.
By: William
W. Deardorff, PhD, ABPP
April 5, 2001
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