Have you ever noticed how some people give in to their back pain while others push through and do whatever they want regardless of the pain? What makes the difference in these two groups of people? What makes one person keep on keepin’ on while someone else just gives up? I’m asking because I’m one of those people who has given up. My pain dictates who and what I am and I’ve quit trying to change that.

You just described two different groups who have been identified and studied. The first group is the persistent group. These folks keep on keepin’ on despite high levels of pain. The second group is (the avoidance group) is more likely to avoid activities, movement, or anything that might make the pain worse. Why does the avoidance group give up?

One way to better understand the difference in behavior among chronic low back pain sufferers is to look at self-discrepancies. These are the differences between how the patient sees him or herself versus how he or she would like to be. Other measurable self-discrepancies include who you would like to be versus who you think other people want you to be. There is also the difference between who you are and who you are afraid to be.

Differences between these conflicting viewpoints can create anxiety, fear, depression, distress, and more pain. Understanding that these conflicts exist, measuring them, and reducing them may help improve function and eliminate disability among chronic back pain sufferers.

Studies show that men are more likely to demonstrate persistent behavior (push through the pain). And patients who were most like who they wanted to be were also more likely to be persistent in their behavior.

But patients who were far away from being their ideal-self were also more likely to engage in persistence behaviors. In both groups (avoiders and persisters), the stronger these behaviors, the more disabled the patients perceived themselves. Overall, higher pain levels translated into poorer perceived quality of life and mental health.

You might think that people who are up and going despite the pain would be close in who they want to be and who they are (called the ideal self). But in fact, one study from The Netherlands showed it was more likely that there is a subgroup of persistence patients.

This subgroup (called endurance copers) overdo in order to “get everything done.” They end up pushing too hard and suffering more pain, which then puts them farther from where they want to be.

Researchers are just in the first phase of making hypotheses (theories) about the relationship between chronic pain and behavior and testing them out. The goal is to find better ways to help and treat patients with chronic low back pain. If it turns out that self-discrepancy behaviors are part of the problem, then treatment strategies directed toward regulating these thoughts and actions may be helpful.