When we experience back pain, sometimes we shift from active involvement in life to "sick role behavior." Sick role behavior includes things such as staying in bed, allowing others to help us with tasks, staying home from work, taking medicine, frequent visits to the doctor, and avoiding physical, social and recreational activities. Sick role behaviors make sense in the early stages of a back injury because they can help with healing and recovery.

Unfortunately, some painful conditions are chronic in nature. Pain in the hands and feet (peripheral neuropathy) associated with diabetes is one example. Other examples include the pain associated with rheumatoid arthritis, irritable bowel syndrome, fibromyalgia, post-polio syndrome and complex regional pain syndrome.

The cause of back pain may or may not be clearly understood. Effective prevention or management of back pain requires active patient involvement. Just as a person with diabetes needs to check his or her blood-sugar level regularly and follow a particular diet, and just as a person with high cholesterol needs to exercise regularly and make dietary changes, folks with back pain need to do their part to manage it. Engaging in sick role behavior when you have chronic pain will only make the pain problem worse. If your pain is related to a recent injury, engaging in excessive sick role behavior will increase the likelihood that your pain will become chronic.

If you have chronic back pain and want to enjoy a higher quality of life, or if you want to reduce the risk of pain associated with a recent back injury becoming chronic, there are a number of things you can do that are likely to result in reduced pain, increased function and increased quality of life. Some of those things include:

• Remaining physically active and involved in all of the regular aspects of your life, even on your bad days.
• If you have been inactive for a long time, you should start working under the guidance of your physician toward very gradually increasing your level of activity.
• If your doctor has cleared you for normal physical activity, don't avoid certain movements or activities just because they have been painful in the past. Instead, work on gradually increasing your ability to engage in movements and activities that you may have been avoiding.
• Don't overdo it on your good days.
• Learn how to relax. It will help with sleep, will reduce muscle tension, will reduce stress and will reduce the negative emotional reactions to your pain.
• Seek help if you have problems with anxiety, depression or substance abuse.
• Maintain a positive, optimistic attitude. Don't let yourself get caught up in imagining about worst-case scenarios such as ending up in a wheelchair, your spouse leaving you or never being able to work again.
• Avoid long-term use of narcotic pain medications.
• Read a good pain management self-help book.

Patrick Davis is a licensed psychologist and works in the Montana Spine and Pain Center at St. Patrick Hospital and Health Sciences Center.