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 TheJournal 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.
Bible verses for today’s meditation and inspiration: Matthew E. McLaren
Psalm 50:14 “Offer to God a sacrifice of thanksgiving And pay your vows to the Most High;
1 Timothy 1:12 I thank Christ Jesus our Lord, who has strengthened me, because He considered me faithful, putting me into service,
Romans 1:8 First, I thank my God through Jesus Christ for you all, because your faith is being proclaimed throughout the whole world.
Colossians 3:17 Whatever you do in word or deed, do all in the name of the Lord Jesus, giving thanks through Him to God the Father.
Hebrews 13:15 Through Him then, let us continually offer up a sacrifice of praise to God, that is, the fruit of lips that give thanks to His name.
Ephesians 5:20 always giving thanks for all things in the name of our Lord Jesus Christ to God, even the Father;
2 Corinthians 1:11 you also joining in helping us through your prayers, so that thanks may be given by many persons on our behalf for the favor bestowed on us through the prayers of many.
Daniel 6:10 Now when Daniel knew that the document was signed, he entered his house (now in his roof chamber he had windows open toward Jerusalem); and he continued kneeling on his knees three times a day, praying and giving thanks before his God, as he had been doing previously.
Psalm 35:18 I will give You thanks in the great congregation; I will praise You among a mighty throng.
1 Thessalonians 5:18 in everything give thanks; for this is God’s will for you in Christ Jesus.
Nehemiah 12:31 Then I had the leaders of Judah come up on top of the wall, and I appointed two great choirs, the first proceeding to the right on top of the wall toward the Refuse Gate.
John 6:11 Jesus then took the loaves, and having given thanks, He distributed to those who were seated; likewise also of the fish as much as they wanted.
Acts 27:35 Having said this, he took bread and gave thanks to God in the presence of all, and he broke it and began to eat.
Ephesians 1:16 do not cease giving thanks for you, while making mention of you in my prayers;
1 Thessalonians 1:2 We give thanks to God always for all of you, making mention of you in our prayers;
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