Changing your beliefs about pain may help relieve chronic back pain, study finds.
- About 20% of people around the world live with
chronic pain.
- One of the most common types of chronic pain is
chronic back pain.
- Previous research shows behavioral modification
techniques like meditation and cognitive behavioral therapy are helpful
treatment options for this condition.
- Researchers from the University of Colorado
Anschutz Medical Campus provide new evidence supporting the effectiveness
of brain-based treatments for chronic back pain.
Chronic
pain can occur in any part of the body. One of the most common types of this
condition is chronic back
pain.
A
recent study by researchers from the University of Colorado Anschutz Medical
Campus provides new evidence supporting the effectiveness of brain-based
treatments for chronic back pain.
This
study was recently published in the journal JAMA Network OpenTrusted Source.
An
estimated 20% of the world’s populationTrusted Source lives with chronic
painTrusted Source — a condition
causing consistent pain that continues for three months or more.
A
study in 2019 found that 39% of adults
in the U.S.Trusted Source live with back
pain. Up to 23%Trusted Source of
the world’s population has chronic low back pain, which is considered the leading causeTrusted Source of
disability worldwide.
Treatment options for chronic back pain include medications, physical therapy, acupuncture, epidural
steroid injections, and surgery. Previous
research also shows behavioral
modification techniquesTrusted Source like meditationTrusted
Source and cognitive behavioral
therapyTrusted Source are helpful
treatment options.
What is chronic back pain?
Chronic
back pain can occur anywhere in the spineTrusted
Source. Most people experience lower back
pain located in the lumbar
spineTrusted Source. However, the location
of the back pain can sometimes be hard to pinpoint.
There
are many reasons why chronic back pain may occur, including:
- spinal cord injury
- improper posture
- muscle atrophy
- repetitive
movements like constant bending over or heavy lifting
- slipped or bulging discs
- spinal
diseases such as arthritis or spinal stenosis
- agingTrusted Source
- back
or spinal deformities such as scoliosis or lordosis
Symptoms
of chronic back pain include:
- pain
(mild to intense), aching, and/or burning that does not go away
- pain
that extends to the legs, hips, buttocks, and/or past the knees
- swelling
in the back
- difficulty
urinating
- fever
- unintended weight loss
The
brain and chronic back pain connection
Over
the past few years, researchers have been studying the link between the brain and chronic back pain.
A study published in
January 2018 found people with chronic low back pain had decreased
activityTrusted Source in certain parts
of their brain involved in the release of dopamine — the body’s “feel good” hormone — that is also
involved in the release of μ-opioidsTrusted
Source that help relieve pain.
And
a review of research published in July 2019 noted that the development of
chronic pain is linkedTrusted
Source to synaptic
plasticityTrusted Source and changes in
the central nervous
system and other neural
areasTrusted Source that regulate
pain.
“For
decades studies have tried to link back pain to back problems like bulging
discs or bad posture,” Dr. Yoni
Ashar, assistant professor of
internal medicine at the University of Colorado Anschutz Medical Campus and
first author of this study, told Medical News Today. “It turns out
these sorts of things only cause relatively few cases of chronic back pain.
Most cases of chronic back pain are caused primarily by brain changes, like the
brain amplifying signals it receives from the back.”
“There are two very important things to emphasize,” he
continued. “First, the pain is always real. Sometimes, it can be caused by
issues in the back and sometimes it can be caused by changes in the brain — but
in all cases, the pain is real. Second, the sorts of brain changes we are
talking about are completely reversible, and recovery from pain is possible.”–
Dr. Ashar
Using
pain reprocessing therapy to relieve chronic back pain
For
this study, Dr. Ashar and his team studied the impact of pain
reprocessing therapyTrusted Source on
people with chronic back pain. Pain reprocessing therapy is a psychological
treatment that teaches people to recognize pain signals sent to the brain as
less threatening.
“Chronic
pain is driven by a cycle of fear and avoidance,” Dr. Ashar explained. “People
very naturally think their pain means their body is injured or broken, so the
pain is perceived as highly threatening, and they avoid doing any activities
that might make (the) pain worse. Once people shift their thinking to see the
pain as due to misfiring brain pathways, they can learn not to fear or avoid
the pain and to help recalibrate those brain pathways to bring down the pain.”
The
study enrolled 151 participants with chronic back pain who received either pain
reprocessing therapy or a placebo. The pain reprocessing therapy included a
one-hour telehealth session with a doctor and eight individual
one-hour sessions with a therapist twice weekly for four weeks.
Study
participants who received the placebo watched two videos describing how
placebos can powerfully relieve pain and received a subcutaneous saline
injection into the back.
Surprising findings on pain recovery
In
a separate 2022
paperTrusted Source covering the
results of this study, researchers found two-thirds of participants treated
with pain reprocessing therapy reported being pain-free or nearly so after the
treatment, compared to only 20% of the placebo participants.
“We
were very surprised (by these findings),” Dr. Ashar said. “In past studies of
different psychological treatments, participants usually reported a reduction
of one or two points on a zero to 10 pain scale. And people hardly ever
reported a full recovery from pain.”
“In
our study, most participants reported a full or nearly full recovery from
pain,” he added. “This speaks to the power of this treatment, and the need to
better understand how the brain can ‘unlearn’ chronic pain.”
Change in pain attributions may offer relief
This
recent paper looked at the effect of pain reprocessing therapy on pain
attributions, which are people’s beliefs about the underlying causes of their
pain.
Before
receiving pain reprocessing therapy, only 10% of study participants’ pain
attributions were mind- or brain-related. Afterward, that percentage increased
to 51%.
“We
found that when we asked our participants before treatment what they believed
to be the cause of their pain, almost no one mentioned the mind or the brain,”
Dr. Ashar said. “Yet we know scientifically that mind and brain processes
contribute to or even generate most cases of chronic pain. There is a big gap
between what most people think is causing their back pain and what we know
scientifically to drive chronic pain.”
“It
may be helpful for doctors to help their patients see their pain as due
to fearTrusted Source, avoidanceTrusted
Source, or brain processes, rather
than injury or damage,” he continued. “In our study, the more people shifted to
seeing their pain as caused by something in the mind or brain, the more their
pain was reduced. Many doctors are worried that their patients will not respond
well to the idea that changes in the brain are driving the pain. But, this is
often a hopeful message because these brain changes are reversible and recovery
from pain is possible.”
The importance of a proper mental space
After
reviewing this study, Dr. Jian Guan, a board certified
neurosurgeon at Pacific Neuroscience Institute-South Bay and Spine Institute at
Providence Little Company of Mary in Torrance, CA, told MNT it
showed the importance of people with chronic back pain being in the right
mental space.
“If you treat chronic back pain, you notice that
absolutely for a lot of patients there is a mechanical and biological reason
for their pain, but a lot of it also is mental.
And a lot of it is something where if you’re not in a
good headspace before the surgery, or if you’re not in a good headspace when
you’re undergoing pain management, you’re really not going to get the best
results possible.”
– Dr. Guan
“Based
on what this study shows, being in that mental space is very important,” Dr.
Guan continued. “I think one of the real strengths of this study is they had a
very nuanced and a very scientific view of how to break that down. I think for
a lot of people they just think if you have a good attitude or something like
that, but they really showed that it was a lot more complex than that.”
MNT also spoke with Dr. Ilan
Danan, a sports neurologist and pain
management specialist at the Center for Sports Neurology and Pain Medicine at
Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, CA, about this study.
“I’ve
been a firm believer in looking at indirect ways in which to address pain
beyond just direct treatments, medications, injections, and such,” Dr. Danan
explained. “And the concept behind the connections between the brain and how
one perceives and interprets pain has been studied on several occasions. And
this study, I think, just further confirms how we can address what we interpret
as centrally mediated painTrusted Source.”
“I
think the more word gets out about ways in which we can address chronic pain,
beyond medications and interventions, I think the more buy-in we’ll get from
our patient base,” he added. “That can be the difficult and challenging issue
at times is patient buy-in (to) this concept. But the overwhelming majority of
patients that do elect to buy into this belief do find tremendous benefit.”
No comments:
Post a Comment