Mind over back pain

Ronald D. Siegel, Psy.D.
Ronald D. Siegel, Psy.D., Contributing Editor

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.

On top of this, it turns out that people in developing countries, 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.

What actually helps back pain

Last week, researchers at the University of Washington published a landmark study 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.

Take action for back pain relief

The excellent news is that for most of us, chronic back pain needn’t derail our lives. CBT is available at many pain clinics, as is mindfulness training.

You might also try on your own. You could explore CBT using the book on which the University of Washington class was based: The Pain Survival Guide: How to Reclaim Your Life. Alternatively, you can try mindfulness practice by following recorded instructions. While there are many resources for these, you can listen for free to some that I recorded at mindfulness-solution.com.

Additionally, for a comprehensive guide to using mindfulness along with rehabilitation to work through chronic back pain, you can consult a book I co-authored on the subject: Back Sense: A Revolutionary Guide to Halting the Cycle of Chronic Back Pain.

Comments:

  1. shriya pal

    The lower body pain includes the low back, gluten muscles, hips and legs. This could be because of muscle strain, degenerative tissues, a herniated disc, sacroiliac joint disease, arthritis of the facet joint or a fracture in the lumbar vertebrae.

  2. Diksha Chakravarti

    Horses for courses…there is no one solution that will help everyone but these various approaches should help most people. Equally, some people like the commentator Angela Lamb, may not be helped by any of these approaches.
    It is audacious to assume everyone’s pain will be affected because for some, nothing will.
    All we can do is keep trying.

  3. Ralph Jerauld

    stressed often negative thinking

    have Myesthenia Gravis neurological disease ( Ocular area)

    exhausted during the daytime hours. Usually after noon

    In the morning is when I have my energy.

  4. Melissa Yuan-Innes, M.D.

    Every study is only a piece of the puzzle. It’s good that one study of 320 people showed a benefit for mindfulness and CBT after one year. It does not mean that every single human being with back pain will be cured immediately by mindfulness and CBT, as @Angela’s pointed out.

    In January, JAMA published Steffens et al’s meta-analysis of 30 850 people showing that combined exercise and education prevent back pain in about 30 percent of patients for a year (http://www.ncbi.nlm.nih.gov/pubmed/26752509).

    Again, exercise and education are not a cure-all, but they help a significant number of people, like @Jeff.

    If you’d like to hear an informed, balanced, yet light-hearted analysis, I invite you to read my latest book, The Emergency Doctor’s Guide to a Pain-Free Back.

    For everyone, best of luck healing and preventing back pain.
    Sincerely,
    Melissa Yuan-Innes, M.D.

  5. Aino Klippel

    Alexander Technique is a psycho -physical method that’s incredibly effective for chronic, non-specific lower back pain. It will change the way you perceive yourself and question habitual thought-patterns that you’ve always taken for granted. It’s tested by randomised-controlled trials, the teachers are well trained and it’s very safe.

  6. Joan Walter

    “You might also try on your own. You could explore CBT using the book on which the University of Washington class was based: The Pain Survival Guide: How to Reclaim Your Life.” This is great sir…. This is very helpful… Thanks for sharing…

  7. Adrian

    It’s absolutely no surprise to Alexander Technique teachers who have shown it’s about the way you “use” yourself (mentally, emotionally, physically) for over 100 years!

    It’s been clinically proven for back pain with NHS funded gold standard randomised trials which were published in the British Medical journal and recommended by backcare.org.uk

  8. Tim van Orsouw

    Even though Dr. Sarno’s books are awesome, in my opinion they are NOT a must-read (anymore). Why do I tell you this? Well, I’ve read all Dr. Sarno’s books, along with 18 more recent Mind-Body books on curing back pain and body pain.

    The best book and the method I use with my clients is the cutting edge Zero Pain Now process and book by Adam Heller. There’s a reason he has a 97.4% success rate with one single session.

    This information, along with my clinical experience does ‘prove’ structural abnormalities like herniated or bulging discs, spinal stenosis and scoliosis are RARELY the cause of your pain.

    So what is causing the pain? Most pain is caused directly by constricted blood vessels, resulting in local oxygen deprivation. In those areas you will find lowpH and increased production of pain substances, causing you to feel pain.

    Why does the autonomic nervous system create constricted blood vessels? To divert attention away from feeling ‘unbearable’ emotions. Most ofter rage, anger, fear, sadness and shame.

    Myofascial trigger point formation is a clear manifestation of this process. Since I’ve been working as a trigger point specialist for 8+ years, the key is to get rid of those muscle knots… but also to eliminate the underlying cause. Just eliminating trigger points only is therefore temporary or just moves the problem to an other area of the body.

    Your best bet is probably to read Zero Pain Now. Other highly recommended books and programs are “The Tapping Solution” (EFT), “Think Away Your Pain” and “Unlearn Your Pain”.

    In conclusion: even though I honor Dr. Sarno in being the initial pioneer in this area, I have found there’s some more effective treatments or programs available now in 2016.

  9. Corpusmentis

    My experience with Dr John Sarno’s work. Remain skeptical but he saved me after dozens of failed therapies

  10. Rocky

    Ronald – is there a direct email for you?

    I had nine surgeries (lower back, #1 and #5 were big ones on damaged tissue – prior to 2001) then fracture/compression in 2014 (Sport motorcycles = safe, $2 sled in VT = this!). Hot Yoga has been great, finally off pain meds but it was a Psych med finally prescribed that made ALL the difference (mental focus on task/not pain + discomfort).

  11. Adrian

    The Mind-Body Connection by Dr. John Sarno is a must read for anyone with back or neck pain. I had serious pain for 10 years I just chalked it up to having a gymnastic childhood, it hurt, I would cry and curse my life until a friend heard an interview with Howard Stern crediting his life to Sarno and healing his pain. Ultimately, the book explains how we internalize our past rage and our bodies manifest it through chronic pain as opposed to dealing with it psychologically. I cured every last tweak of pain just by doing personal mental and writing exercises from this book for about 2 months.

  12. Fran

    Dr. John Sarno, look him up.

  13. Angela Lamb

    I have back pain plus sciatic pain. Had surgery. Do yoga and meditate. Exercise and ride a recumbent bike. Take care of my own house and am very active. 71 years old. STILL have back pain. It is not in my attitude. I believe your research may be valid but am tired of all this questioning pain. Pain is pain. It is chronic. I live with it but it does hurt.

    • Jeff

      Pain is pain. You are correct. Had three back surgeries for scoliosis >25 yrs ago, i do not want to go under the knife again until last resort. I deal with it and take ibuprofen occasionally. Stretch ritually every am and pm. Really helps. Got to keep moving!