I’m probably an unusual patient because I’m going to say that I think my chronic back pain is stress-induced. I don’t seem to have much in the way of reserve or coping skills. How do I go about checking to see if this is true and what to do about it?

Many people with chronic low back pain suffer loss of function and disability that is very limiting. The challenge of coping with a chronic problem can be overwhelming — even for the strongest individual. Recognizing the role of anxiety, depression, and inability to cope is a big step for many people.

The place to start may be with your primary care physician. He or she can help you find the right psychologist or behavioral counselor. You’ll probably spend some time being interviewed and filling out a few surveys with questions that will help identify problem areas for you.

Some people also experience fear-avoidance behavior. Fear-avoidance refers to the concept that people in pain often stop moving in ways they think might cause their back to hurt or cause another injury. The result of that behavior is more pain from the altered movement patterns or avoidance of movement. There is a specific questionnaire to help assess patients for this behavior, too. Addressing this area can help restore function even if pain is not any less.

Studies have shown over and over that there’s a strong role for behavioral and psychologic distress. Pain-related fears, poor coping skills, and fear-avoidance behaviors can be challenged and changed. The result can be improved function, fewer participation limitations, and greater quality of life.