Psychological factors often play a significant role in the development of and adaptation to chronic low back pain (Goldberg 1999, Kendall 1999). Pre-existing depression, anxiety and stress, together with lack of effective coping skills, may predispose individuals to back pain. Research has shown that having a variety of coping strategies, a person's belief in their ability to control their pain, and the level of catastrophizing about their condition is strongly associated with healthy adjustment in chronic pain patients and their families (Simmonds, 1996). Some believe that psychological factors such as these are primary causes of back pain (Sarno, 1991). Distress, whether secondary to physical restriction or to pain, may aggravate the pain and thus the disability (Simmonds 1996). A vicious cycle can be established in which pain causes stress or stress causes pain, and both produce more stress, anxiety and/or depression which causes more low back strain and pain.
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