After months of back pain, I finally turned myself into the doctor for help. All the medical tests were negative, so I was tested by a team of rehab specialists. They felt I would benefit more from psychologic counseling than from an intensive physical training program. I don't think I have a mental problem. What good is this counseling going to do?

Many programs for low back pain include intensive exercises that the patient may not need. If spinal flexibility, strength, and endurance all test within the normal range, then greater attention is given to the work environment and psychologic status.

It doesn't mean the patient has a mental disorder. But many studies have shown that psychosocial factors can play a key role in chronic low back pain (LBP). For example, fear of pain and fear of work-related activities that might cause pain change the way a person moves. Fear of pain caused by movement results in a gradual decline in function.

Pain, loss of motion, and loss of function create distress, anxiety, and depression. The patient starts to feel more and more disabled by the pain and its effects. Getting back to work may not be possible until these psychologic factors are addressed.

Physical exercise has been shown to help reduce LBP and improve mood. For this reason, exercise is usually combined with a program that has a psychologic or counseling focus. Both together can help patients overcome attitudes and fears toward physical, work, and even leisure activities.

Program With Active Individual Physical Therapy for Patients with Chronic Low Back Pain: A Randomized Controlled Trial. In Archives of Physical Medicine and Rehabilitation. October 2007. Vol. 88. No. 10 Pp. 1229-1235.

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