WebMD BlogsPain Management

The Low Back Pain Treatments Your Doctor Isn’t Telling You About

650x350_back-pain
Peter Abaci, MD - Blogs
By Peter Abaci, MDBoard-certified anesthesiologist and pain specialistApril 20, 2018

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.

WebMD Blog
© 2018 WebMD, LLC. All rights reserved.
Blog Topics:
About the Author
Peter Abaci, MD

Peter Abaci, MD, is one of the world’s leading experts on pain and integrative medicine and serves as the co-founder and Medical Director for the Bay Area Pain & Wellness Center. He is a dedicated healer, author, and radio celebrity. To learn more about Dr. Abaci, visit his website.

More from the Pain Management Blog

  • gut microbiome

    Can Your Gut Health Impact Your Pain?

    You may have noticed that at any given moment your pain levels can fluctuate based on many different variables, including the weather ...

  • woman smiling

    5 Ways to Boost Your Pain Management

    Right about now there is a good chance that you have been thinking about ways you might “hit the refresh button” on your pain management ...

View all posts on Pain Management

Latest Blog Posts on WebMD

View all blog posts

Important: The opinions expressed in WebMD Blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. Blogs are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service or treatment.

Do not consider WebMD Blogs as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare provider because of something you have read on WebMD. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. WebMD understands that reading individual, real-life experiences can be a helpful resource, but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider. If you think you may have a medical emergency, call your doctor or dial 911 immediately.

Read More