How Psychological Distress Can Cause Physical Pain in Your Neck and Back

A new study conducted by researchers from The Ohio State University and the University of Michigan in the US has found that the crash of conflicting beliefs jousting inside your head could leave you with more than just an aching brain. It could cause physical pain in your neck and back. Volunteers were asked to lift lightweight boxes while being told they were doing an unsatisfactory job, and the researchers found that the resulting psychological distress added extra pressure on participants’ necks and low backs.

The Biopsychosocial Model of Pain

Researchers like biomechanics researcher William Marras have come to appreciate that pain involves a complex interplay between body and mind. Pain is a heady mix of physical, social, and psychological stressors, meaning it can manifest out of physical strain coupled with financial stress and mental ill-health. Even the words a doctor uses to describe low back pain can shape someone’s expectations of recovery. Orthopaedic surgeon Gordon Waddell wrote back in 1987 that to achieve the goal of treating patients rather than spines, we must approach low-back disability as an illness rather than low-back pain as a purely physical disease.

Cognitive Dissonance and Back Pain

Most research to date has revolved around the coexistence of chronic pain with depression, anxiety, and a tendency to catastrophize. Marras and colleagues wanted to understand if another psychological factor, cognitive dissonance, also impacts back and spine pain. Cognitive dissonance arises when you attempt to reconcile multiple, seemingly incompatible beliefs, causing anguish that drives us to seek some kind of mental relief.

The Study

Marras and colleagues designed a series of experiments to see whether this psychological discomfort manifests physically, similar to how depression and anxiety can exacerbate pain. In the lab-based study, 17 volunteers were tasked with moving a lightweight box into precise positions while wearing motion sensors to measure how much load they were putting on their spines and backs. During practice runs, they were told they were moving in the right way to protect their backs. But then the feedback became increasingly negative, the participants were told they were performing the task in an unsatisfactory way. When comparing the participants’ discomfort scores to the mechanical loads on people’s spines, the researchers found that peak spinal loads increased by between 10 and 20 percent when people felt distressed by negative feedback compared to when they were feeling capable at the start of the task.

In other words, repeated psychosocial stressors may place greater strain on the spine, leading to pain. The loads on the lower back also increased, but only slightly. This latest study adds another dimension to the growing body of research, which is helping to understand what adds to people’s pain in order to relieve it. Understanding the psychosocial dimensions of pain appears to be helping greatly, and studies have found that adding psychological therapy to physical treatments might be key to overcoming chronic back pain. Trials of more holistic models of care, including group therapy, have reduced opioid use without worsening pain. For those who can move uninhibited, remember that low back pain is more than a niggle; it’s the leading cause of years lived with disability worldwide. A recent analysis of three decades of data found that in 2020, nearly 620 million people globally had low back pain – impacting their ability to work, move, travel, or care for themselves or others. That figure is expected to rise to over 800 million people by 2050.