Back pain: will a treatment for the mind, body or both help you?

If you’ve ever suffered from lower back pain, you know it can be surprisingly debilitating, even if the discomfort is short-lived. You may find it difficult to do your shopping, clean the house, play sports or even tie your shoelaces. When back pain is chronic and lasts 12 weeks or more, it can impair quality of life and physical function and contribute to or worsen stress, anxiety and depression.

While people with chronic back pain are often referred to physical therapy, research shows that psychological approaches that teach strategies for managing your pain experience can help. So, would the combination of these approaches do more for pain relief? A recent systematic review of several studies suggests that might be the case.

How big is this problem and what did this study find?

Worldwide, low back pain is a leading cause of disability and affects more than 560 million people. In the United States, four in 10 people surveyed in 2019 had suffered from low back pain in the past three months, according to the Centers for Disease Control and Prevention.

Posted in TheBMJ, the review relied on 97 studies of adults with nonspecific chronic low back pain, with or without leg pain. Using statistical models, researchers compared the effectiveness of therapies aimed at improving

• physical function, such as standing, climbing stairs, and managing self-care
• fear avoidance, as fear of pain can cause people to avoid moving, which contributes to the cycle of muscle weakening and further pain
• pain intensity, measured by pain scores from validated rating scales.

The review found that physical therapy combined with psychological approaches, such as pain education and cognitive behavioral therapy, improved chronic low back pain more effectively than physical therapy alone. More precisely:

• To improve physical function and avoid fear, pain education programs combined with physiotherapy provided the most lasting effects.
• To improve pain intensity, behavioral therapy combined with physiotherapy provided the most lasting benefits.

The study shows the benefits of an interdisciplinary approach to chronic low back pain. The integration of behavioral therapy and physiotherapy has helped people function better, reduce the cycle of avoidance behavior, and reduce the intensity of their pain. In their daily lives, this can lead to more productive workdays and better sleep, while allowing people to participate in more social activities, which improves overall well-being.

What else should you know about this study?

The authors define chronic nonspecific low back pain as pain between the bottom of the rib cage and the gluteal fold, with no identified structural cause such as spinal stenosis, cancer, or fracture.

However, “non-specific” is a controversial term. Many back pain experts believe that further evaluation could determine specific, multiple factors contributing to pain.

A physiatrist, also known as a physical medicine and rehabilitation physician, can diagnose a range of pain conditions and help people navigate therapies to manage back pain.

Additionally, the authors noted that reporting of socioeconomic and demographic information was poor and inconsistent in the included studies. This means that the conclusions of the study may not apply to everyone.

How do psychological therapies help relieve pain?

Psychological therapies can help people reframe negative thoughts and change pain perception, attitudes, and behaviors. Examples of approaches to reduce pain-related distress are cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), mindfulness-based stress reduction (MBSR), biofeedback and pain reprocessing therapy (PRT). A recent study evaluating PRT showed that psychological treatment focused on changing beliefs about the causes and consequences of chronic low back pain can provide substantial and lasting pain relief.

Neuroscience has demonstrated that the brain and the body are always connected and that pain is a combination of medical, cognitive, emotional and environmental issues. Strategies for effectively managing pain should address your body and brain by integrating physical and psychological therapies, such as functional restoration programs and working with a pain psychologist. Understanding pain better and addressing all of the factors that contribute to your chronic pain can be empowering and healing.