Spinal problems are caused by the three T’s – trauma, toxins and thoughts. Trauma is the physical forces that affect the spine directly, toxins refer to what we consume and thoughts are the mental stressors which may affect the spine. Today, we will focus on the third factor – our thoughts, and how they contribute to spinal problems. What we think is how we perceive and what we perceive often becomes reality for us. Our thoughts play a huge role in how we see the world around us. Yellow flags are psychosocial factors which may portend an episode of spinal problem becoming chronic. Therefore, it is important to recognise yellow flags and provide appropriate interventions to reduce the chances of acute episodes becoming chronic conditions.
One of the more widely used models to assess these yellow flags is the Bio-Psycho-Social model. This model targets all the aspects of a person’s life in order to assess their likelihood of developing a chronic condition. Early identification of the yellow flags, and early treatment of spinal problems, may be effective at preventing chronicity. The psychosocial factors which have been identified as contributing factors to the development of chronic conditions are:
- Depression
- Mental distress
- Fear avoidance beliefs
- Poor coping strategies
- Initial perceived risk of persistence
- Poor treatment expectations
- Extended bed rest
- Waiting for claims and compensation
- Non evidence-based treatments
- Social withdrawal
- Delayed return to normal activities
Further, the factors which focus on this risk of an acute episode of back pain becoming a chronic condition begin with the person’s attitude towards their LBP. Patients often think of the worst case scenario and believe that they are suffering from a serious illness. Faulty beliefs about their current situation can cause catastrophisation and poor outcomes of treatment, leading to long-standing chronic conditions. Medical jargon, miscommunication and poor diagnosis can cause misunderstanding. If the patient does not understand the meaning of the explanation given to them then they can have mixed thoughts about their condition.
Moreover, patients with emotional difficulties and mental health issues such as depression and anxiety may have a greater likelihood of developing a chronic condition. In these cases, a strong social support system can often benefit these patients and prevent their condition from progressing. On the other hand, social circle can be over-bearing at times and it is important to find a good balance.
Work and professional commitments can often cause frustration for people with acute conditions. The better the professional relationships, and the smoother the working environment, the less likely they are to develop chronic spinal problems. Factors such as an unsatisfactory work environment (socio-occupational) can influence outcomes in LBP. For example, an unhappy and stressed person at work may have a high chance of transitioning from an acute pain to a more chronic condition.
Next time you experience a spinal condition, gather all the yellow flags in your life and study the effect of your thoughts and social circle on your spine!
Article by Dr Sarkaw Mohammad
References:
Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychological Bulletin, 133(4), 581-624 doi.org/10.1037/0033-2909.133.4.581
