Stress and Back Pain

Which Comes First?


A study from the Centers for Disease Control (CDC) estimates that 34 million people suffer from low-back pain (LBP).[i] The CDC classifies LBP as a critical public health problem.


Stress is also widespread. It was originally intended to warn of a serious threat to survival. But today the natural stress response has morphed into a chronic problem, because people lead increasingly “unnatural” fast paced lives.


In a classic chicken or egg quandary, researchers have questioned whether stress triggers physical pain. Or, does pain create stress? According to Dr. Greif, the answer is that they feed off of each other, no matter which one come first.


A wealth of scientific research supports the link between these two common conditions.


For many, back discomfort and stress go hand in hand. In fact, there is scientific proof that pain and psychological distress may be causes and consequences of each other.[ii]


For instance, a study from the Rosalind Franklin University of Medicine and Science found that patients with already established chronic LBP may be more susceptible to stress.[iii] Other studies indicate that stress exacerbates back pain.


Work Is Often a Trigger


Dr. Greif often observes that work is a major source of stress for many patients.


One recent analysis found that the #1 work related health complaint was stress, affecting about 27% of participants.[iv] Interestingly, the #2 complaint was backache at about 18%.


Some professions have exceptionally high rates of both back pain and stress. For example, flight attendants under heavy stress from job demands also have an elevated incidence of LBP.[v]


And a study conducted in Sweden finds that on the job psychological stress is just as damaging as physical exertion. Researchers from the Karolinska Institute in Stockholm found that burned-out mentally exhausted employees have the highest rates of back pain.[vi] These same employees report elevated levels of psychological stress, including anxiety and depression.


Breaking the Cycle


Psychological factors may reduce the effectiveness of any care plan for treating low back pain.[vii] So, chiropractors believe that it is key to attend both issues in order to break the brutal cycle.


Chiropractic focuses on correcting vertebral subluxations. Vertebral subluxations are dysfunctional segments in the spine, which occur when spinal bones (vertebrae) are slightly out of place, or not functioning properly.


People who undergo chiropractic care for conditions such as low back pain are more likely to notice improvement in their symptoms.


Many studies show that even severe LBP is reduced by chiropractic approaches, which offer “great pain relief”.[viii] Chiropractic may also be part of a larger solution because it offers psychological benefits for patients as well, and can improve quality of life.[ix]


The effectiveness of chiropractic care for relief of LBP and stress can be measured by patients’ satisfaction. Techniques commonly used in chiropractic provide high levels of satisfaction and physical functioning, along with mental health benefits.[x]


The Mind Worsens Pain


While it is logical to assume that psychological traumas instigate emotional problems, many people to not realize that these same events also influence the development of chronic pain.[xi] This relationship is demonstrated by research, which determined that people who have more stress also have more pain[xii] as calculated by biomarker levels, such as stress chemicals in the body.


Originally, our stress response was triggered rarely and only by impending danger. These days, our frenzied lifestyles elevate the stress response to critical mass for long periods of time. This persistent activation alters hormonal balance, and in turn causes additional stress as well as physical impairment of many bodily processes.[xiii]


Research has proven beyond a shadow of a doubt that high levels of stress hurt your body. Other mental and emotional conditions can have a detrimental impact on the body as well. Anger, for one, increases muscle tension near the site of an injury; and can cause pain in addition to aggravating existing LBP.[xiv]


Of course, chronic pain of any sort is frightening. A large number of studies have looked into the relationship between pain and an individual’s tendency to focus on the worst case scenario. Psychologists term this habit “catastrophic thinking” which triggers additional stress.


Many people with LBP share the common fear that their pain indicates serious injury.[xv] Other LBP patients who’ve had symptoms for a long time worry that the pain means they’re well on the way to becoming disabled, or will have the pain forever.[xvi]


These stressful beliefs strongly influence whether a patient will actively engage in treatment. A “catastrophic” attitude can also have a direct effect on whether the chosen care strategy will work, or not.[xvii] Researchers advise tackling these negative thinking patterns directly, which can help patients deal with their pain realistically.


How Chiropractic Addresses Emotional Wellbeing


Researchers believe that the additional time chiropractors spend with their patients contributes to overall patient satisfaction. Studies have shown that greater satisfaction boosts the odds of recovery.[xviii]


Back pain patients who are under tremendous psychological distress find that chiropractic alleviates suffering from both conditions.[xix]


Another analysis indicates that joint manipulation may lower stress. Researchers measured the levels of stress markers in the circulating blood after chiropractic care, and found the levels were significantly lower.[xx]


Supplemental Strategies


Your doctor may suggest additional strategies for back pain and stress relief to try in conjunction with chiropractic adjustments. These strategies include but are not limited to some of the ones listed here.




Reflexology is particularly well suited to help manage LBP.[xxi]


Reflexology uses massage and pressure point therapy on the feet, and sometimes the hands, to promote calmness and healing. In one UK survey, 94% of respondents said that reflexology had a positive effect on their LBP and provided relaxation as well.[xxii]




A study from 2007 showed that regular, high-intensity aerobic exercise reduces pain and “psychological strain” in patients with chronic LBP.[xxiii]


Another study advocates participation in fun, physical recreational activities for people with both LBP and stress. While targeted back exercises did not help these study participants, less structured choices did alleviate pain and improve psychological health.[xxiv]


It’s Time to Break Free


Back pain and stress are ‘all in your head’. If you are caught in this discouraging cycle, there are many factors to address. This office has targeted strategies that work, so ask for an appointment today!



[i] Arthritis Rheum 2007;57:656-65.

[ii] J Clin Epidemiol 2003;56:463-71.

[iii] Emotion 2006;6:180-92

[iv] Med Lav 2008:99:9-30.

[v] J Adv Nurs 2008;61:492-502.

[vi] J Adv Nurs 2008:62:84-95.

[vii] Health Care Women Int 2008;29:339-48.

[viii] J Manipulative Physiol Ther 2004;27:358-65.

[ix] JSVR 2008:1-7

[x] Spine 2003;28:1355-62.

[xi] Pain 2008;134:69-79.

[xii] Eur Spine J 2008;17:393-405.

[xiii] Chiropr Osteopat 2006;14-25.

[xiv] Emotion 2006;6:309-19.

[xv] Clin J Pain 2007;23:720-5.

[xvi] Spine 2006;31:1038-46.

[xvii] Spine 2008;33:966-72

[xviii] Spine 2005;30:2121-8.

[xix][xix] JVSR 2006:1-6.

[xx] J Am Osteopath Assoc 2007;107:387-400.

[xxi] Complement Ther Med 2008;16:3-8.

[xxii][xxii] Complement Ther Med 2008;16:9-14.

[xxiii] Phys Ther 2007;87:304-12.

[xxiv] Am J Public Health 2005;95:1817-24.


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