Study finds when does back pain become chronic?

Professor Monika Hasenbring has long been exploring the question of how individual pain processing affects the development of chronic complaints, because she is aware that they are not a purely medical but also a psychological phenomenon.

Four risk groups:

As head of the Department of Medical Psychology and Medical Sociology at Ruhr-Universität Bochum (RUB), she developed a model of pain processing years ago, in which patients are assigned to one of four groups. This model helps customise diagnosis and therapy approaches to the individual risk groups.

The first group’s response to pain is fear, and members of that group typically interpret it as a symptom of a serious illness. Accordingly, these individuals avoid any situations that could possibly trigger the pain. Inactivity and muscle weakness are the result, which in turn bring about pain and bad mood.

Rallying cries lead to more pain:

The second group is made up of individuals who suppress the pain :– both mentally and in their behaviour. They force themselves to bear up with rallying cries such as “Don’t make a fuss” or “Don’t think about the pain”. A strategy that does not necessarily have a positive outcome, because these patients don’t take their time to relax. This can also lead to an increase in pain.

Members of the third group are patients who are able to distract themselves from the pain. They manage to maintain a positive attitude. However, as they also tend not to take care of their body, they also often experience an increase in pain.

Balancing stress and relief:

Only people assigned to the fourth group succeed in reducing their pain through their attitude and behaviour. “These individuals react quite flexibly to the pain,” as Monika Hasenbring describes her findings. “They find a balance between stress and relief and take breaks from time to time, but they don’t avoid physical activity.”

Top athletes, too, suffer from back pain:

Monika Hasenbring is currently investigating whether this model can also be applied to top athletes suffering from back pain. As part of the nationwide interdisciplinary research network Medicine in Spine Exercise, which was funded by the Federal Institute of Sports Science under the label “Ran Rücken”, she compared data from the general population with that of 200 athletes who reported suffering from back pain. The surveys showed that although one might think that top athletes have a special relationship to their bodies, they resemble the general population in terms of their risk factors for the chronification of back pain; they match the same pattern.

“These findings can help patients, because the cognitive attitude towards pain is something we can change through psychotherapy,” explains Hasenbring. “If we can teach patients to recognise the cycle of thoughts and pain reinforcement in which they are trapped, we can also show them solutions for handling the situation.”