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Lumbar FAQs

I just came from seeing the physician's assistant at our local clinic. I've been having trouble with low back pain for the last six months, and they can't figure out where it's coming from. He asked me a lot of questions about being depressed. Does this mean he thinks it's all in my head or just an emotional problem? I'm not getting anywhere with this problem.

Nonspecific low back pain occurs in a wide range of people of all ages and backgrounds. There are an equal number of different reasons behind their back pain. Mood and psychosocial factors can certainly be a part of the big picture.

In fact, many studies have shown now that psychosocial issues are a key factor in patients who develop chronic pain. If you've had back pain for six months now, then you fall into the definition of someone who is having a problem with chronic pain.

When infection, tumor, or other more serious cause of back pain has been ruled out, it's a good idea to look more closely at the psychosocial piece of the puzzle. Many studies have shown now that the presence of anxiety and/or depression makes a difference.

Patients are less likely to respond to any kind of therapy or treatment if there was a high level of distress before treatment. This is true whether they have surgery, physical therapy, or some other form of treatment. Higher levels of distress actually predict greater pain and disability over the course of follow-up.

It sounds like you are in good hands if your PA knows this and is making an effort to explore all areas of possibility with you. It's probably not the case that he thinks this is all in your head. A good health care professional recognizes all factors (including psychologic and social) that can contribute to a problem.

References:

Robert R. Edwards, et al. Symptoms of Distress as Prospective Predictors of Pain-Related Sciatica Treatment Outcomes. In Pain.July 2007. Vol. 130. No. 1-2. Pp. 47-55.
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