If you’ve been feeling like your doctor visits aren’t doing much to help your low back pain, there’s now some research to back you up. The health journal, The Lancet, recently published a series of articles looking at how we treat back pain, and the gist of their findings is that most of us who go to a doctor for an aching back are probably receiving inappropriate or unnecessary treatment. According to the researchers, the most common missteps by doctors include over-reliance on medications including opioids, pushing bedrest and avoidance of activity, emphasizing tests like x-rays and MRIs too quickly, and depending too much on invasive treatments like injections and surgeries. So, what should doctors be suggesting instead? The authors offer these evidence-based recommendations: more education about pain management, resuming of normal activities, exercise, and “psychological programs for those with persistent symptoms.” My guess is that this last recommendation – that we need more in the way of psychological treatments for low back pain – caught you by surprise.
Though back pain is a physical problem – there is tissue inflammation and irritation that needs to be treated – it’s actually better viewed as an experience, and one that can encompass a vast array of elements including emotional and psychological factors. On any given day, the emotional reactions that are generated in connection to our pain, along with the thoughts, attitudes, and judgements that arise, all contribute in important ways to our low back pain experience.
The way bodily pain gets processed in our brains is strongly linked to the same circuits that handle thoughts and feelings. For example, the onset of low back pain can trigger a stress cascade leading to feelings of fear, anxiety, worry, irritability, or depression. High levels of psychological distress, along with catastrophizing, where we can only see the worst in a situation, have been tied to a higher chance that pain will become ongoing. Ignoring these types of factors only leads to more suffering and poor outcomes.
So, what can be done psychologically to help improve the situation?
Anything that can help improve your outlook and diffuse an over-agitated nervous system can be helpful, but there are some specific psychological approaches worth looking into:
- Pain Psychology - Several sessions with a psychologist or therapist who specializes in pain management can help you learn useful tools and strategies. Cognitive-behavioral therapy is a well-established form of psychotherapy that focuses on reprocessing dysfunctional thought patterns to decrease emotional distress. Another promising psychological approach used in the treatment of pain is Acceptance and Commitment Therapy (ACT) which promotes improving psychological flexibility as a way of overcoming health challenges.
- Mindfulness - Mindfulness works on activating brain relaxation pathways as a tool to relieve pain and reduce stress and anxiety. Some studies have shown that practicing mindfulness can improve pain and well-being for patients with conditions like chronic low back pain. Mindfulness-based stress reduction (MBSR) is a structured 8-week program geared to teach useful mindfulness-based techniques, and these courses can now be found in many communities.
- Progressive Muscle Relaxation - Muscles that surround and support the spine and pelvis often tense up as a protective mechanism after a back injury, but when that tensing continues and doesn’t let up, it can lead to more pain and problems with mobility. Learning tools and techniques to relax these over-activated muscle groups can reduce discomfort and improve function.
- Multidisciplinary Programs - Combining psychological treatments and education with exercise and movement can be an effective way to treat challenging back problems. In my own practice, we offer something known as a functional restoration program which is a structured 6-week, 6-hour/day program that combines psychology classes with exercise and other modalities. A more comprehensive approach has the advantage of working on all aspects of the pain experience in a coordinated way.
Unfortunately, in many communities these types of recommended treatments are often not available or not covered by insurance. If you are having trouble finding local resources, consider looking into telemedicine for an on-line therapist or check out apps geared toward relaxation training and meditation. And don’t forget that emotional well-being can get a boost in many other ways including exercise, social bonding, listening to music, yoga, tai chi, and just getting more fresh air.