What are the psychological mechanisms in chronic low back pain (cLBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Psychological manifestations are 3-fold; they include behavioral, cognitive-affective, and psychophysiological mechanisms. Guarded movements, nonverbal and verbal expressions of pain, and inactivity are called pain behaviors. Normal healthy behavior patterns may become extinguished when these verbal and nonverbal pain behaviors are reinforced by environmental factors.

Cognitive-affective mechanisms often contribute to the perception of chronic pain. Pain complaints are common in depressed individuals, and patients with chronic pain frequently become depressed. Depression acts though biochemical processes similar to those that operate in chronic pain; this may enhance symptoms through a synergistic relationship. Patients with pain who are depressed may illogically interpret and distort life experiences, further complicating the feasibility of treatment or employment.

Psychophysiological mechanisms naturally triggered by pain and injury can lead to generalized muscle overactivity, increased fatigue, and other pain problems (eg, tension myalgia, headache). The emotional stress that pain induces tends to heighten norepinephrine activity and the general activity of the sympathetic nervous system, which may further amplify nociception by means of peripheral or central mechanisms.

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