My psychologist says I have chronic back pain because I'm so stressed. I maintain that I'm stressed because I have constant back pain. Which is it?
You could both be right. Studies conclusively show that psychosocial distress is a key factor in chronic low back pain (CLBP). But whether psychosocial distress ia a cause or the result of CLBP is much like the chicken and the egg. No one knows for sure which came first.

It makes sense that anyone with chronic pain of any kind is both stressed and distressed. But studies also show that people who are distressed are more likely to develop back pain. Distress is defined as abnormal or heightened stress responses.

Distress manifests itself in a variety of ways. Anxiety, depression, and fear top the list. Uncertainty, anger and hostility, and increased awareness of the body are also subsets of distress.

No matter which it is, dealing with distress is essential when treating back pain. Patients should be tested for types of distress and management or treatment geared toward the findings. For example, insomnia (difficulty sleeping), agoraphobia (fear of public places), and somatization (body pain as a result of anxiety) are identifiable and treatable.