To the surprise of doctors and patients alike, accumulating research suggests that most chronic back pain isn’t actually the result of illness or injury. Study after study indicates instead that back pain is very often caused by our thoughts, feelings, and resulting behaviors. And an exciting new study now demonstrates that treatments aimed at our beliefs and attitudes can really help.
When our back hurts, it’s only natural to assume that we’ve suffered an injury or have a disease. After all, most pain works this way. When we cut our finger, we see blood and feel pain. When our throat hurts, it’s usually because of an infection.
But back pain is different. There simply isn’t a close connection between the condition of the spine and whether or not people experience pain. Research has shown that a majority of people who have never had any significant back pain have the very same “abnormalities” (such as bulging or herniated spinal discs) that are frequently blamed for chronic back conditions. And then there are the millions of people with severe chronic back pain who show no structural abnormalities in their back at all.
In my experience in developing countries like India where poor laborers in unfavorable circumstances, who do back-breaking labor and don’t have easy access to medical treatment, have much fewer incidents of chronic back pain than people in the developed world who sit in ergonomically designed chairs, sleep on fancy mattresses, and have ready access to spinal imaging, surgery, and medications!
Because there’s so little correlation between the condition of the spine and any given person’s experience with back pain, clinicians and researchers have begun looking instead at treatments that address the psychological and behavioral patterns that can lock people into years of suffering. And they’ve just demonstrated that two of these treatments work much better than traditional medical interventions alone.
In 2016, researchers at the University of Washington published, “Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain” in The Journal of the American Medical Association that showed training people with chronic low back pain in either mindfulness or cognitive behavioral therapy (CBT) works significantly better than medical care alone to reduce both their disability and pain-related suffering. The researchers randomly assigned 320 adults, ages 20 to 70, to either an eight-week class in one of these methods, or to “usual care.” The subjects who attended the classes saw significantly more improvement in their pain and disability than those receiving usual care — and this greater improvement was still evident a full year later, when the study ended.
Mindfulness training teaches us to be aware of, and accept, moment-to-moment physical sensations of discomfort, while letting go of our usual negative reactions. So instead of spending hours each day thinking about how much we hate our back pain, worrying about our prognosis, and seeking relief, we learn how to be with the pain — paying attention to how it actually feels at each moment and relaxing our tendency to tense up against it, while observing our worried or distressed thoughts and feelings coming and going.
CBT takes a somewhat different approach. It helps us learn to observe and identify our negative thoughts about our condition, and replace them with more realistic ones.
Both methods help us see the functioning of our minds more clearly, and the role that anxious, angry, and frustrated thoughts and feelings about our condition play in increasing our fear and stress.
And as it turns out, it is precisely this fear and stress that maintains most chronic back pain. This explains why events such as childhood physical and sexual abuse, painful losses, and job dissatisfaction have all been shown to be risk factors for the condition.
HELP AT YOUR DOOR STEP FOR PAIN RELIEF
The excellent news is that for most of us, chronic back pain needn’t derail our lives. CBT is available at Dandenong Neurology & Specialist Group, as is mindfulness training.
By A/PROF SANJAY RAGHAV
MBBS, MD, DM, FRACP
