Four years ago I had a disabling car accident. I haven't been able to go back to work since because of severe back pain. My doctor tells me the pain isn't a sign of harm, and that I can do anything I want to. How can I do that when every movement hurts?

Many people who have had accidents or injuries with long-lasting symptoms face this dilemma. If painful symptoms persist past the time for expected physiologic healing, then your pain becomes chronic instead of acute. Most soft tissue and bone injuries take six to 12 weeks to heal.

Pain from injury, stretch, or trauma to any of the nerve tissues is called neuropathic. This type of pain can last much longer. If the nerve is able to heal or regenerate, then your symptoms may improve over a period of 12 to 18 months. Once again, pain after that time period becomes chronic.

When the doctor told you the pain isn't a sign of harm, he or she was referring to the fact that in cases of chronic pain, the pain is not a signal that you are injuring or re-injuring yourself. It's likely that you will have the pain no matter what you do.

In other words, whether you sit in a chair or remain active, you'll have the same painful response. If that's the case, then patients are encouraged to remain as active as possible. The situation becomes one of pain control or management rather than cure.

Douglas J. French, et al. Fear of Movement/(Re)injury in Chronic Pain: A Psychometric Assessment of the Original English Version of the Tampa Scale for Kinesiophobia (TSK). In Pain. January 2007. Vol. 127. No. 1-2. Pp. 42-51.