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Chronic back pain is the most common cause of disability worldwide, but it can be challenging to manage. A program that emphasizes the mind-body connection, however, may have benefits, according to a pilot project reported in the journal Pain.Back pain is a challenging chronic condition because a structural cause is frequently difficult to determine, says study co-author Michael Donnino, MD, a physician in the departments of critical care and emergency medicine at Beth Israel Deaconess Medical Center (BIDMC). For instance, there might not be sufficient spinal injury to justify the patient's claimed level of discomfort.
“This type of pain may be driven by stress or repressed emotions,” Dr. Donnino notes. “The exact mechanism remains unclear, but an analogy could be made to other known effects of acute emotional states on physiological changes.”
Doctors at BIDMC employed a 12-week program that includes mindfulness-based stress reduction with sessions of two hours each, completed once per week for eight weeks, to treat 35 individuals with persistent back pain. The participants also went to a six-hour long full-day program (retreat).For four weeks, they also went to sessions twice a week aimed at lowering anxiety and worry. Getting back into meaningful physical activity was another component of the approach. At the conclusion of the trial, there had been a considerable increase in general function, along with decreased discomfort and anxiety.
Even when compared to usual therapy, they discovered that the program was very effective in treating back pain, and the results could have long-term consequences. Six months after the program's conclusion, about 64% of participants said their discomfort was entirely gone.
According to Dr. Donnino, the physical causes of pain are the emphasis of the current paradigm for pain management. Non-specific back pain occurs when there doesn't seem to be one; it may be caused by a psychological process, such as blushing, which is when blood rushes to the face as a result of feeling embarrassed. Similar to how excitement or anxiety can result in "butterflies in the stomach," these alterations in the digestive tract can also occur.
Similar to some types of back pain, sudden traumatic news can cause what is known as cardiogenic shock, also known as "broken heart syndrome," which can be much more serious. For back pain, Dr. Donnino suggests that treating the stress rather than the pain it is causing may go a long way toward alleviating both issues.
“When patients recognize this relationship between the mind and their physical pain, this sheds new light on the issue,” he says. “That has the potential to be highly beneficial.”
For example, a study published in July 2021 in Scientific Reports examined 8,473 adults with and without low back pain to examine any potential associations between emotional wellness and back pain. It's interesting to note that 357 people with chronic low back pain and 1,697 people with no back pain both reported being under a lot of stress. Researchers advised stress awareness and control as part of back pain treatment because those with the pain generally had substantially greater stress levels.
According to Gabriele Buruck, PhD, a professor at the Technische Universität Dresden in Germany, even workplace-related back problems, which are frequently thought to result from poor ergonomics and excessive sitting, could have a psychological component. She and fellow researchers examined 18 studies involving more than 19,000 people and discovered that those who felt less supported at work were significantly more likely to have chronic back pain.
"Back problems are often attributed to incorrect posture or sitting for too long,” Dr. Buruck says. “But we were able to show that factors like workload, job control, and social support significantly contribute to the development of [chronic back pain] as well."
Taking any action to address emotional health concerns may be helpful for treating persistent back pain, she says, even if this program is not yet accessible to the general public. This could involve techniques like mindfulness and stress reduction, as well as CBT and career adjustments.
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