Back pain conditioning is one explanation for the often illogical symptoms and expressions suffered by many patients. Conditioning, also known as programming, is a virtually inherent part of any chronic pain syndrome, regardless of whether the working diagnostic theory is purely structural discomfort or psychological back pain as the root cause.
Conditioning is a term that describes the expectation of a specific result from a particular activity or behavior. When it comes to back ache, the most commonly expected event is pain. However, when studying how and why conditioning takes place, what you are actually researching modern psychology and not physical medicine. This comes as a shock to patients who are trying to cure a seemingly structural ailment, such as dorsopathy.
Remember, the mind influences the anatomy in all that it does and all that it feels. Therefore, one can not discount the role played by the mind in the cause, severity and timeline of back pain, or any other significant health crisis.
Pavlov is famous for his experiments showing how a specific response can be created from a related event. Just like Pavlov’s dogs were made to salivate at the mere sound of a bell, back pain patients can be made to experience symptoms from ordinary and often coincidental circumstances. Regardless of the cause of back pain experienced by a patient, psychological conditioning is virtually always a crucial part of the symptomatic expression.
All patients create a partially factual and partially circumstantial clinical picture of their back ache. This is a completely normal and expected reaction to the desire to avoid pain. A patient will determine all the things that actually or perceptually help and harm their symptomatic condition. Things that make it better on the left, things that worsen it on the right. This creates a set of psychological rules and guidelines by which the patient will attempt to live. All of this is done to stop a recurrence of the dreaded pain.
Some of the precautions and guidelines may be based on actual cause and effect. However, many are illogical and may be downright humorous when viewed objectively, were it not for the patient's true belief in the causative or curative qualities imparted.
Patients with long-term chronic back pain often have long lists of prohibited behaviors. I have heard of so many ranging from the plausible to the absurd. I must admit to having a few of these guidelines, as well. Here are some of the more common conditioned responses:
I can only sleep on my side.
Sitting is bad for my back.
I have to keep exercising, but not should not overdo it.
Chiropractic adjustments are needed to keep me functional.
Patients often demonstrate a severe acquired physicophobia.
Every patient has their own individual lists of preferred and prohibited behaviors and some of them are truly comical. Some of my favorites reported to me from actual patients are:
My back hurts more watching certain TV channels than others.
My back hurts at exactly 11:34 PM every night.
My back hurts when shopping, but I can walk for hours outside.
My back pain goes away when I wear purple.
These are all real beliefs reported to me during patient interviews. Obviously there is some underlying reason why these occur, but they are certainly not due to the overly simplified explanation believed by the patient themselves.
The truth of conditioned responses is that the mind likes to create rules for all things. The body experiences pain during a particular event or action and instantly creates an assumption that the pain is somehow caused by said event/action. Sometimes this makes perfect sense, but often, the rule is illogical and downright senseless.
Conditioned responses train us to treat the pain as if it was a separate entity that must be coddled and cared for like a new born baby. It is amazing to me how some patients become completely focused upon their self-made rules of pain.
However, the more you learn about psychosomatic pain syndromes, the more you will discover that this preoccupation with the symptoms which reside in the physical body is the exact goal sought by the subconscious mind to protect the consciousness from repressed emotional issues.
This is the goal: utter and complete preoccupation with physicality and pain.
If you are one of the many patients who have a long do and don't list when it comes to back pain, you need help. There is a very good chance that all these prohibitions and placebos are actually making things much worse for you.
Research has shown that when these programmed behaviors are removed from the mix, patients often improve, even when they have long histories of treatment-resistant symptoms in the past.
All these behavioral contributors are the very fuel on which mindbody syndromes run, but the psychological overlay of conditioning can have negative consequences on even the most structural pain diagnoses, as well.
Knowledge therapy is a treatment which can help root out and resolve conditioning concerns. It is time to seize back the reins of your life and tell back pain to take a hike.
You can do it. If you want to truly recover, you must.