Stress: definition and common causes

Editor: What is stress exactly?

Sophie Wenzel: The term “stress” can include a lot of things. It’s essentially the body’s physical and psychological response to exceptional demands. The body mobilizes certain neurotransmitters in the brain as well as hormones, like cortisol and adrenaline, so it can be quick, efficient, and focused. This response helps us find ways to cope with the demand. It’s a “special program” for particularly challenging situations – it’s not meant to be a constant state. That’s why stress responses exhaust body and soul if they’re called upon too often.


Editor: What are common causes of stress?

Sophie Wenzel: Sophie Wenzel: Many different stimuli can trigger stress. They can be negative as well as positive: a sporting competition or particularly taxing tasks at work count as stress that encourages our body to perform at its best. To a certain degree, stress is part of life. Of course, people respond differently to it, depending on their physical condition and cognitive abilities. Two factors are significant in determining whether we see the situation as a burden or a challenge: how long the stressful situation persists and whether we have the feeling that we can influence events, meaning we don’t feel helpless.


Eine Person fasst sich an den Rücken und signalisiert, dass sie Schmerzen hat.

Stress and back pain

Editor: What connection is there between stress or psychosocial strain and back pain?

Sophie Wenzel: The following mechanism is quite logical: severe and ongoing mental tension leads to permanent stress for the body, even during sleep. It manifests, for example, with tense muscles and changes in posture, which, in turn, cause pain in the back and neck.

We now know that in a large proportion of people with back pain, psychosocial causes are a major contributor to acute back pain becoming chronic. It’s therefore crucial that these causes are identified early. Unfortunately, patients with physical problems often fear that others don’t believe they’re in pain if mental factors are assumed as the cause. They may be accused of just imagining the pain. This is detrimental and based on a widespread misunderstanding. The pain exists, but the cause may be of a psychological nature.


Mental stress can lead to back pain – and vice versa.

Dr. Sophie Wenzel
Specialist in Psychiatry and Psychotherapy

Editor: Which stress triggers or psychosocial factors often lead to back pain?

Sophie Wenzel: A depressed mood is often named as a trigger for non-specific back pain. This mood is almost exclusively the result of work-related, family-related, and other “psychosocial” stress factors. Just to name a few of these psychosocial problem areas: they may include financial worries, too much but also too little demand at work, tension and a lack of appreciation by colleagues, long journeys to work, a lack of family support, the family fighting, worries about a sick family member, as well as difficulties with the partner which are not talked about, and loneliness.


Of course, people without a tendency to develop depression can also be under constant stress and therefore get back pain. This can be caused by ongoing stress, perhaps because they are trying to balance their private and professional lives. Women are particularly vulnerable in this context. On the other hand, there are those who have excessive work ethics and completely disregard their own limits, always thinking they have to do better because it’s never good enough. Interestingly, stress at work often arises when people have to accomplish a lot but can’t join in the decision-making process. If, however, someone is allowed to make decisions and contribute ideas, a large work load can be more easily managed and can even feel good.

The crux of the problem is usually the same: we don’t know our own limitations, we’re not aware of them, and don’t respect them, or we have the feeling that we’re helpless in a situation. We must therefore realize when we’re not just challenged but overburdened.


Editor: Can back pain lead to stress?

Sophie Wenzel: Definitely. We have to take into account that a stress response is triggered to cope with a huge burden. Pain is a warning signal – the body must think of something so the pain will stop. Pain is therefore a good reason for a stress response. In cases of non-specific back pain, there is practically no reason to rest. Yet those affected often have the feeling that this is what they should do. This may result in people withdrawing and avoiding company. Add the fact that they have to put a lot of effort into being active because of the pain. Even everyday tasks seem more difficult, and activities that are usually enjoyable lose their appeal. This means that back pain leads to a physical stress response, directly and indirectly.


Editor: Is it a kind of vicious cycle, i.e. back pain leads to stress and this stress increases back pain?

Sophie Wenzel: It’s actually a classic example of a vicious cycle. The first step is cutting out exercise because of pain and adopting a posture to help relieve pain. It’s understandable in a way because pain can be worrying. But a lack of exercise leads to muscle atrophy, muscle cramps and hardening, all of which causes even more back pain. It becomes problematic when “pain memory” is triggered. Constant pain can lead to pain receptors responding to pain more sensitively in the long term. The pain goes rogue in a way, it loses its function as a warning signal, and becomes harder to treat.

If people withdraw or rest, it may become more difficult to deal with everyday tasks, they may gain weight, and become unhappy etc. That can make it very difficult to think positively. This negative mood, in turn, advances back pain.


Actively combating back pain

Editor: How can back pain be dealt with effectively?

Sophie Wenzel: The goal should be not to let back pain get the upper hand over one’s life but to regain the feeling that one is able to influence the pain.

In the vicious cycle that is back pain, negative thoughts play a significant part: we may already know that exercise may alleviate our back pain. Yet we have thoughts like “I better have a little rest today, otherwise the pain will never stop.” These types of thoughts promote avoidance and lead us further into the vicious cycle, meaning they’re not helpful at all. If we realize that we can influence our thoughts, we can take a step back and analyze them.

Using techniques from the area of cognitive behavioral therapy, we can identify destructive, negative thoughts as such and actively address them. Sentences like “I know it’s hard but after exercise I’ll feel much better” are positive and focus on a solution. If I can now put this sentence into action, I will probably notice that exercise has a positive effect on my back pain. This good feeling will probably encourage me next time not to hesitate so long but to get straight to it.


Some people are worried about taking pain medication. But in some cases, something can be said for taking pain medication. It makes getting active and exercising easier again. It’s also good to know which methods of relaxation help, such as heat cushions or a bath.


Orthoses and supports that can be used whenever needed also complement pain medication well. They relieve the spine and stabilize the back, which provides additional confidence during exercise.

To be happy despite back pain and to overcome it in the long term, you may have to dial back the goals relating to your back pain, meaning perhaps not aiming for “complete freedom from pain”. Knowing what resources are available to make the pain more bearable helps.


Editor: Are there any general behavioral tips to cope with stress and pain more effectively in the case of non-specific back pain?

Sophie Wenzel: In order to get rid of back pain and to prevent it, sufficient exercise is crucial. Taking the stairs instead of the elevator, cycling short distances to work, including a walk to round off the day. Exercise, especially in the fresh air, reduces stress and clears the mind.

A lot of people suffering from back pain are worried though and don’t dare to do certain exercises. Wearing an orthosis can help in this case because it supports the back and increases confidence. People can then happily get back to being active.

Relaxation methods, such as progressive muscle relaxation according to Jacobsen, can help those who feel constantly tense. A lot of people also enjoy yoga and Pilates because they combine exercise and relaxation.

At work, we should make sure to take regular breaks and just push it aside as much as possible for a moment. You may even be able to go for a small walk or eat your lunch in the fresh air. In any event, we should briefly leave our main work place if possible.


Editor:  When should patients with back problems seek help from a psychotherapist?

Sophie Wenzel:  If we can’t get rid of our back pain over an extended period despite trying everything, and we may even increasingly withdraw from social activities, family duties, and hobbies; if we additionally take sick leave more frequently, are constantly sad and depressed, meaning the back pain is taking over more and more, it interferes with sleep, and cuts us off from a happy life, then it will be time to consider whether psychotherapy may be an option.