See part 1 here.
Let’s start with a big questions that I will only briefly answer as the topic is vast!
What is Pain?
The International Association of the Study of Pain defines pain as the following:
"An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage” IASP Definition of Pain
There are two critical points I’d like you to take away from this definition1:
The use of the word ‘emotional’.
The phrase ‘potential tissue damage’.
On the subject of #1, even if back pain isn’t caused by emotional stress to begin with, it can often end up being involved in chronic pain cases as the person becomes more frustrated and despondent with their lack of progress. As well as strong emotions being associated with pain over time, previous experiences matter. If you’re expecting, looking for or fearing pain, you’re more likely to feel it. Dissociating your negative emotions and thoughts from your pain can be an integral component for rehab.
With regards point #2, ‘hurt does not always equal harm’. You absolutely can have pain without any visible signs of damage (and vice versa). Check out one such study’s results, which have been shown time and again in various similar studies.
Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27. PMID: 25430861; PMCID: PMC4464797