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Myth Busting 8: Faking it – low back pain to get disability payments

· 4 min read

Part of the "Myth Busting" series

Brace yourselves for this one.

From our last myth busting post we learned that pain is influenced by many different things. It's affected by stress, previous experience, beliefs and environment. It's linked to tissue damage, or potential tissue damage, but not in isolation. Pain is actually a more accurate indicator of perceived threat than of injury. We also discussed how pain is not an input from the body, but an experience created by the brain. And there's an obvious question that comes from that.

Are they faking it?

There's a huge stigma around musculoskeletal (MSK) pain, and low back pain especially. Lots of people assume that it's an easy condition to fake to be lazy at work. You could get light duties, or a medical redundancy with a sweet payout (pretty rare) and live a cushy life on benefits (ever tried living on less than £150/w?)

Now clearly there are a whole tonne of political and moral implications of the welfare system and how it's run. It's not my job to discuss any of those here.

From a clinical point of view, people who tend to get stigmatised in this way fall into 2 categories.

  • People who are not in pain, but lie and say that they are
  • People who are in pain, but this cannot be linked to an injury or disease

And in this blog post today I really only want to make 2 points.

1. It's actually very hard to consistently fake being in pain when you're not.#

A doctor, occupational health worker or even an observant work colleague would soon notice if you claimed it was agony to bend forward but you didn't seem to have any trouble tying your shoe laces in full flexion. In fact, there are whole TV shows dedicated to following people claiming benefits with hidden cameras.

2. No-one would ever choose to be in pain.#

If you've understood from my previous blog posts that pain is an experience created by the brain, then you might think that people who have chronic pain can simply choose not to. They just need to tell their brain that, nope, actually it doesn't hurt, and they'll be magically cured. And if they don't do that then they must be choosing to be in pain, for whatever self-serving, attention-seeking reason.

But we're forgetting that pain is really unpleasant. Many people who suffer in chronic pain would say that it affects their whole life. They struggle to work. They can't do anything they enjoy. They're on a whole cocktail of drugs with unpleasant side effects. They are physically and mentally exhausted from their pain. No-one consciously chooses that.

Now, psychologically speaking, there may be some sort of secondary gain from that person being in pain. But this is not something that the person consciously chooses. This often happens at a deeper, more subconscious level.

The stigma of low back pain#

I said at the beginning of this article that low back pain seems to be the real target of this stigma. People don't often roll their eyes and say "Yeah he's off work with chest pain - the slacker". Even when it isn't assumed to be fake, people still treat low back pain differently.

If you had a friend come to you and say:

"I'm really struggling with a recent bereavement and I feel it like a pain in my chest"

You may think that was perfectly reasonable. If another friend came to you and said:

"I'm really struggling with all this stress at work and I feel it like a pain in my back"

You might think that sounded ludicrous. But it isn't. All pain has biological, psychological and social elements. No pain is 100% about tissue damage or injury. All pain has to be ascribed a meaning by the brain. And so both of these statements should be treated as equally valid. But they're often not.

And, unfortunately, when people in pain are stigmatised because of their pain, the sense of isolation and helplessness that brings makes it worse. Not better.

See other posts in the "Myth Busting" series