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The link between back pain and your emotions

profile picture of Will Kenton
MSK Physiotherapist at Bupa
25 May 2022
Next review due May 2025

Lower back pain is very common – around 6 in 10 people will get it at some point during their life. In most cases, back pain gets better within a few weeks with some simple self-help measures. You may not need to have treatment. But sometimes, your pain may last longer and affect your daily life and work. You may feel low or emotional, which can make your pain feel worse.

Treatments for back pain can involve both physical and mental techniques. Here I’ll explain how staying active and adopting a positive outlook can help you to manage your back pain and get better more quickly.

How do emotions affect back pain?

How you feel and respond to pain is a really complex process. There’s the physiological process – what’s happened in your body to cause the pain. And there’s the psychological process – how your brain reacts to the pain. Your pain may be very real. But your perception of it (how bad it feels) and its impact on you are strongly influenced by your feelings, attitudes and beliefs.

For example, you may notice that your pain can feel worse if you focus on it or feel negatively about it. Your pain will also have a greater impact on your daily life if you’re feeling stressed or low. If you avoid the activities that you think are related to your pain, this can make your recovery take longer.

There is plenty of research on certain things which can slow your recovery. Here are some examples.

  • Believing that pain and activity are harmful. These may be your own beliefs, but they can be reinforced by people who may be trying to protect you.
  • Negative actions can reinforce the belief that you’re unwell – for example, staying in bed for a long time.
  • Having a low or negative mood, depression, anxiety or stress.
  • Having low expectations of how well treatment will work.
  • Relying too much on treatments that don’t help you to slowly increase your physical activity levels and emotional resilience. Examples of these treatments include painkillers, hot and cold packs, massage and electrotherapy.

Managing your emotions and feelings to relieve back pain

Managing your feelings and beliefs about your back pain can help you to work through your pain and get back to normal. This is known as psychological therapy. There are different approaches to treatment, which may focus on the following areas.

  • Your behaviour and actions – looking at the things you’re currently doing to manage your pain and how you may be able to improve this.
  • Your thoughts and feelings – aiming to identify and change the negative feelings you may have about your pain and how to deal with it.
  • Your body’s response to pain – learning strategies to manage your body’s reaction to pain, such as tension in your muscles.

Psychological therapy is more likely to help with your pain than just using standard medical treatments and physiotherapy alone.

How to start therapy for back pain

If your back pain continues, speak to a GP. They can advise what treatment is best for you. They will ask about your symptoms and how you’re managing with your pain. A GP may recommend you try talking therapies, and physiotherapy. Who you’ll see or where you’ll go for this treatment will depend on the services available in your area.

A GP may be able to refer you to a pain clinic at your local hospital. Pain clinics involve teams of health professionals, including doctors, psychologists and physiotherapists. They often run specific group-based pain management programmes for people with similar problems.

Or, a GP may refer you to a physiotherapist who can provide a combination of both physical and mental treatments.

Types of talking therapies

Two examples of talking therapies are cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT). Rather than focussing on trying to reduce pain, these can help you manage it.

  • In CBT, your therapist helps you to think differently about your pain and to develop strategies for carrying out your daily activities.
  • ACT is a development of CBT and includes mindfulness to help you accept the situation rather than living with pain and trying to avoid it. There is some evidence that it can make your pain feel less severe.

You can have either CBT or ACT individually or as part of a group.

What will happen in talking therapy for back pain?

During therapy such as CBT or ACT, you’ll be taught to identify things that cause your pain or make it worse. Your treatment may involve one or more of the following.

  • Putting strategies in place to help you manage your back pain in a healthy way. This may involve removing unhelpful factors such as relying too much on painkillers. By focusing on increasing exercise instead can help you go back to your normal activities.
  • Identifying any negative beliefs and feelings you have about your pain. You can then work out how to change them.
  • Relaxation therapies, such a breathing techniques. These can help to reduce tension in your muscles and help with your pain.

Psychological therapy may not make your pain go away. But, it can help to reduce it. The therapy can also help you to manage your pain, so that you can recover faster.


If you have a muscle, bone or joint problem, our direct access service aims to provide you with the advice, support and treatment you need as quickly as possible. If you’re covered by your health insurance, you’ll be able to get advice from a physiotherapist usually without the need for a GP referral. Learn more today.

profile picture of Will Kenton
Will Kenton
MSK Physiotherapist at Bupa

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