Don't Let Back Pain Paralyze You

Confronting fear of movement critical to recovery, experts say

WEDNESDAY, Aug. 28, 2002 (HealthDayNews) -- Anyone who has ever had back pain knows the idea of moving around can be terrifying, but experts say facing your fears is critical to recovery.

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, an associate professor of behavioral medicine at Maastricht University in the Netherlands. He spoke on the topic last week at the 10th World Congress on Pain in San Diego.

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 "hypervigilant," 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, 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."

What To Do

For more information about back pain, go to the National Library of Medicine or the American Academy of Orthopaedic Surgeons.

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