We tend to give psychological and social factors less relevance in the generation of pain. To understand the contribution of these factors it is useful to imagine a glass that would represent the ability of our body to withstand different stressors (eg tissue damage or irritation, psychological stress, work or family problems …) without developing pain. Once we have this image of the glass in mind, we will consider that once filled, the pain will manifest. In this case, the biological factors (damage or irritation of the tissues) will be water, and the psychosocial factors will be ice cubes.

If we put only the ice cubes, it is complicated that the glass overflows (and therefore manifests pain), at least in the short term. But if we add water (in this case the damage in a tissue), the presence of ice cubes (psychosocial factors) will cause the glass to overflow more easily (that is, pain appears).

With this analogy in mind (which I hope you have been clear) we will analyze what the evidence says about how these factors affect back pain. If you still have not been very clear, in this video we give some other examples of how the pain system works in broad strokes, and how the pain can originate without there being any damage to the body:

We have seen how anxiety and depression are comorbidities of low back pain, and how these factors reinforce abnormal movement patterns, bad lifestyle habits (excess rest and isolation), increase tissue sensitization and increase disability (1, two). In addition, these factors have been associated with an increased risk of chronic low back pain (3).

It has also been seen how fear of movement and avoidance of activities are related both to a worse prognosis of low back pain (4) and to a worse prognosis before treatments (5). So keep rest or be afraid to move your back and lift loads is not going to help you recover, but quite the opposite. That is why it is important to have the help of a professional who helps you to gradually expose your column before loads and gestures, with the peace of mind that will tell you what you can do safely.

Catastrophism is another factor that has been related to a worse evolution of low back pain (6). The catastrophism is those typical behaviors or thoughts of helplessness, believing that you will never recover and that there is no solution to your problem. Unfortunately, this type of behavior is due to a bad education about the problem (erroneous information on the Internet, nocebos by the toilets …) and a mistaken belief that passive treatments are better than active ones. Which leaves the patients in this position and with these thoughts.


We should not ignore these types of factors when we suffer from low back pain. We are human beings, not a set of tissues, devices, and systems that work together. So our beliefs, thoughts, behaviors and the environment that surrounds us have repercussions on our experiences, and among them is a pain.

It is not easy to change beliefs and certain behaviors when we talk about people experiencing pain, but the first steps are those that make the road to recovery. Do not be afraid to move because that will be the main tool to recover your quality of life and relieve pain.


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