Text: Melinda Marchese
Photo: Heidi Diaz

"There are lot of misconceptions"

Liliana Belgrand insists on the importance of taking a biopsychosocial approach. This expert has been monitoring patients with chronic low back pain for 20 years.


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IV What causes back pain?

LB Apart from the wear and tear of the anatomical structures due to age or injury following an accident, for example, several factors can cause pain. A poor position held for too long or an improper movement can create a muscle inflammation that becomes painful. We talk of “acute pain”, which goes away after a few days with a bit of rest and anti-inflammatory drugs. It must not be left to turn into chronic pain.

IV How can it occur?

LB All pain affects people both physically and mentally. It can leave traces, and some types are deeper than others. When a patient is in a complicated family situation, they can let themselves be overrun by the pain and gradually give it an important place in their thoughts. If they lose control, they risk changing their perception and making it chronic. There are a lot of misconceptions about back pain, especially that all back pain is due to an injury and that the pain is proportionate to the damage. And also that persistent pain is a sign something is seriously wrong.

IV So it’s “all in their heads”?

LB No, the pain is very real. The treatment should not simply be restricted to the organic cause that we’re address- ing with drugs or surgery. Today, we recommend taking a “biopsychosocial” approach, meaning that we also con- sider psychological aspects and the social environment in which the patient lives. A person who’s been in pain for years is very often depressed, doesn’t sleep well, etc. Their health worsens, and that can lead to both social and professional isolation. Before even prescribing an X-ray, the patient should be asked about their family and social life. That’s why we need multidisciplinary care to get the best results when treating such complex pain. ⁄