This material is for informational and educational purposes only and is not medical, psychological, or psychotherapeutic advice. If you are experiencing an acute psychological condition or need professional support, please contact a doctor, psychologist, psychotherapist, or crisis service.
At the end of the day, someone gets up from their desk and carefully straightens their back. A work conversation is still running through their mind, shopping bags are waiting in the kitchen, and tomorrow involves another journey. “I carry everything on my own” suddenly feels very accurate. It may capture tiredness and loneliness in responsibility. It cannot, by itself, explain why the lower back hurts or what care is needed.
Conversations about the body can slip from an evocative image into a confident explanation: a sore neck means stubbornness; painful knees mean fear of moving forward. This creates a ready-made story in which the person must find the “wrong” feeling. It is more useful to examine daily demands with an open question about what is happening, alongside attention to medical causes.
When medical help is needed
This is educational information, not individual advice. Seek emergency help for back pain with new bladder or bowel dysfunction, loss of sensation around the genitals or anus, weakness or numbness in both legs, chest pain, or following a serious accident. Sudden severe pain, rapid worsening or fever needs urgent assessment.
A hot, swollen joint, especially with fever, also needs urgent assessment. After injury, inability to bear weight, deformity or lost sensation warrants emergency care. These lists are incomplete: do not wait for a writing exercise to work when new concerning symptoms appear.
Sharing plans and daily demands backstage at a theatre. AI-generated editorial illustration, not a depiction of treatment.
Pain is a real experience
The International Association for the Study of Pain describes pain as a personal experience influenced to varying degrees by biological, psychological and social factors. This allows us to take a bodily symptom seriously while also asking about feelings and living conditions. Someone does not have to identify one definitive cause to prove that their pain is real.
Backs and joints can hurt for different reasons. An injury, inflammatory disease, nerve irritation and other conditions need appropriate assessment. In some cases of low back pain, a specific cause that fully explains the symptom cannot be identified; WHO describes this as non-specific low back pain. That is a clinical description, not a conclusion about hidden resentment.
Existing narrative illustration: writing at the end of the day.
What the location of pain cannot tell us
A tense neck cannot establish that someone refuses to change their views. A painful knee does not reveal whether they fear the future, and low back pain does not measure how much responsibility they carry for others. The same person can have difficult relationships and a condition that needs treatment. These aspects of life do not exclude each other.
A metaphor can sometimes start a useful conversation. “I carry too much” might mean that someone cares for a relative, works overtime and has nobody to share household tasks with. We can then ask what they actually do, who could help, and which commitments could change. Those are concrete circumstances worth addressing whether or not pain changes immediately.
Turning a metaphor into a diagnosis can obscure other information. A person might search for unexpressed anger instead of mentioning swelling, an injury or new weakness. An accurate description is more valuable here than an elegant interpretation.
Existing metaphorical illustration of demands; the image does not establish a cause of pain.
Where stress fits into the picture
A demanding period can change the whole day. Someone spends longer at their desk, goes to bed later and misses familiar breaks. Someone else checks sensations more often and becomes frightened by every change. A note can help show what is actually happening to you without deciding in advance that stress caused everything.
The relationship can run in the other direction too. Pain disrupts sleep, limits activities and makes uncertainty harder to live with. A person becomes irritable, sees friends less often and starts dreading the next workday. These experiences deserve support in their own right, even when a medical cause is known.
A biopsychosocial perspective broadens the discussion of care. For chronic primary low back pain, WHO recommends individually tailored, integrated support, including education, exercise programmes and other appropriate interventions, which may include psychological therapies. This guidance concerns a defined condition, not every cause of joint pain or any recent injury.
What to discuss with a clinician
Before an appointment, briefly note where the pain is, when it began, whether there was an injury, and which movements or activities have changed. Add any swelling, numbness, weakness or fever, what has become difficult, and which medicines or other measures you have already tried. Mention sleep and workload too. A description does not need to be perfect to be useful.
You can ask, “Which possible causes are you considering? Which changes would need a further appointment or urgent help? What can I do until we next meet?” If pain persists, a clear plan for further assessment and support is more useful than the general explanation “it is your nerves.”
NICE guidance on low back pain does not recommend routine imaging for everyone: it should answer a clinical question and inform management. Discussing this can clarify your clinician's decision; an article is not a reason to independently decline investigations they have recommended.
Movement and workload need a practical plan
After a consultation, “look after your back” can remain frustratingly vague. What does it mean for desk work, travel, shopping or caring for a child? Ask for an explanation relevant to your own activities. This makes it easier to distinguish temporary restrictions from activities you can gradually return to.
Low back pain guidance includes attention to manageable activity and rehabilitation. But an online exercise cannot be selected simply because it is labelled “back pain,” and advice for the lower back should not automatically be applied to a hot, swollen joint. If prescribed movement worsens symptoms or new symptoms appear, discuss this with your practitioner.
Ordinary organisational changes can help with daily demands: dividing shopping, asking for help moving items, or agreeing on work breaks. These actions do not promise to treat the cause of pain. They reduce the number of tasks someone must face alone.
Existing illustration: a pause during everyday activities.
One brief note instead of constant body-checking
Choose one episode for a note, such as an evening after a work shift. Record which symptom you noticed, what happened before it, what interfered with usual activities, and which question you want to ask a practitioner. You can add intensity using a chosen scale if useful or agreed with your clinician. Comparisons make sense within your own records.
Leave a separate line for a thought and a feeling. “I am frightened I will have to stop working” describes an experience, not a prediction. “The pain increased after today's shift” describes a sequence but does not establish a cause. This distinction can make conversations about both symptoms and concerns more precise.
If writing prompts continuous body-checking and increases anxiety, reduce the frequency or pause. A journal should leave room for life rather than demand an account of every sensation. A few important observations are enough to take to an appointment.
Four fields for a brief note before an appointment. Not a diagnostic test.
Using MriyaRun materials
CBT SHIFT, Part 1 includes writing exercises for noticing automatic thoughts, emotions and alternative explanations. Alongside this article, you might examine the thought “If I need help, I am no longer capable of anything”: which parts are facts, which are assumptions, and what would be more accurate? Medical decisions remain something to discuss with a qualified practitioner.
Photograph of materials from the CBT SHIFT series.
The Mistress of Her Boundaries Journal can be used for another part of the situation: agreements and daily demands. You might prepare a specific request: “We need to divide the shopping this week. What can you take on?” A question about boundaries concerns interaction; it neither establishes the cause of pain nor assigns blame for illness.
Photograph of the Ukrainian edition of the boundaries journal.
Both are suggested uses of ready-made self-reflection materials. You can begin the same notes in an ordinary notebook. Whether speaking with a clinician, psychologist or someone close, it helps to distinguish what you noticed from what you fear and what you want to request.
What might change in an ordinary day
Previously, after a hard day, someone might still have carried all the shopping alone because asking felt uncomfortable. Now they can arrange help, write down symptoms for an appointment and clarify their activity plan. None of these actions requires first discovering a hidden psychological cause.
“I carry everything” can remain a useful opening for a conversation about life. From there, look at the actual tasks, medical needs, fears and available support. The back can stop being a text that must be correctly decoded, while the person gains more concrete ways to look after themselves.
Dmytro Telushko. Author photograph.