The best treatment for chronic back pain? See a psychologist

Living with chronic back pain is bound to make you nervous.

This is the unpredictable pain that develops from an injury – whether it’s a sudden, awkward movement, a car accident, poor posture, or wear and tear. at age – and which was inflamed and tight for more than three months.

In most cases, no cause can be determined – yet it is a common cause of disability around the world.

What has become evident in recent years is that chronic low back pain is a monster with two heads: one that has a physical element and a psychological element.

It has become widely accepted that exercise is the foundation of treatment for chronic back pain – different people needing different types of exercise, determined and supervised by a physiotherapist.

But there is also growing recognition that psychotherapy – especially cognitive therapy (CBT) – is necessary to enable the injured patient to adhere to the exercise program.

A new study investigated the overall success rate of treating back pain using a combination of exercise and CBT – and determined which of these had the biggest impact on achieving a rate. higher success.

It’s exciting – and we’ll get to that.

The psychological link

There’s an understandable resentment among people with chronic back pain that their condition might be best explained as a problem in the brain, not the spine. But the evidence is piling up.

In September, we reported on a new study concluding that we need to radically move away from the traditional way we treat chronic back pain.

Researchers from UNSW Sydney and Neuroscience Research Australia (NeuRA) have argued that we should no longer think of chronic back as a disc, bone or muscle problem, but rather redefine it as a modifiable problem of the nervous system.

This idea removes drugs and treatments that focus on the back such as spinal manipulation, injections, surgery, and spinal cord stimulators.

Almost anyone who suffers from chronic back pain will complain that these treatments offer short-term relief at best and do little to resolve the resulting disability.

The new treatment focuses on retraining how the back and brain communicate – and has been shown to provide clinically significant benefits in a 12-week randomized controlled trial.

But this is the start. The treatment was found to be superior to the use of opiates, to a modest degree.

Placebos reduce pain in some people

In 2018, we reported that scientists had found they could reliably predict which patients with chronic back pain would respond to a sugar pill or a placebo.

People with particular brain structures and psychological traits have been found to experience a significant reduction – up to a third – in the intensity of their pain.

And the benefits were enjoyed even when patients were told they weren’t receiving pharmaceuticals.

“Their brains are already tuned to respond,” said study lead author A. Vania Apkarian, a professor of physiology at Northwestern University Feinberg School of Medicine.

“They have the proper psychology and biology that puts them in a cognitive state that as soon as you say, ‘This can ease your pain,’ their pain gets better.”

Some harsh realities

Meanwhile, there are realities that people with chronic back pain have to face – proof that the way they think and behave about their pain is causing problems.

On the one hand, there’s the exhaustion that comes with living on hot coals, where you nurse every move – and your day-to-day functioning is compromised.

Of course, and any suggestion that you imagine this pain can make you feel belittled, insulted, enraged and – to add injury to insult – hurt more than ever.

But the hard truth is that these attempts to shield yourself, coupled with the nervous expectation that pain will lurk behind every corner, do indeed make the pain that much more intense.

The exercise challenge

The other hard truth is that exercise is widely considered the most effective intervention in the management of chronic low back pain – or at least the starting point for most patients.

If you have a half-decent doctor, they’ll explain to you what situation you’re in – movement is a key part of managing your chronic back pain, but you’re afraid of movement because you expect it hurts you.

And with that expectation, then yes, it will probably hurt you.

Chances are you’ll walk out of your GP surgery with a sheet of stretching exercises, maybe some painkillers for the tough times and some advice on how to overcome your anxieties.

No doubt the doctor insisted that if you can’t be bothered with the stretching and strengthening exercises suggested, walk regularly – which isn’t bad advice.

It’s better than nothing

The GP will most likely have offered you a referral to a physiotherapist – and it’s worth seeing one at least once or twice, as different people need different exercise programmes. And it’s not easy.

According to a 2016 systematic review of the effects of exercise and physical activity on chronic nonspecific low back pain, too much or too little physical activity may be associated with low back pain, suggesting that physical activity as a that intervention is complex.

The authors note that, in general, patients are recommended to remain physically active, as long periods of inactivity will impair recovery.

They note that physical activity to increase aerobic capacity and muscle strength, particularly of the lumbar extensor muscles, is important “for patients by helping them perform activities of daily living.”

Other exercises focus on core stabilization, muscle strength, and flexibility programs.

However, the most effective form of exercise as a rehabilitation method for chronic low back pain “is unknown”.

The simple answer, most likely, is that it all comes down to what a particular patient needs. There is no simple answer.

The new study

According to a new meta-analysis from Goethe University Frankfurt – in which data from more than 10,000 patients were combined and analyzed – therapies for chronic back pain that are “tailored specifically to a patient’s individual needs , the chances of success are much greater than with standard forms of treatment”.

The pain relief success rate was 38% higher than standard treatment.

“The greater effort required for individual treatment is worth it because patients benefit to a clinically significant extent,” said lead author Dr Johannes Fleckenstein of the Goethe Institute of Sports Science.

This standard treatment being painkillers and some exercise.

But this is where it gets interesting

When individualized physical therapy is combined with cognitive behavioral therapy (CBT), “pain can be relieved even more effectively.”

Through CBT, patients learn to change the way they manage pain.

“They stop being afraid to move or learn tactics to cope with pain,” the researchers said.

“It makes them realize that they are in no way powerless.”

Ok, but what real difference does CBT make?

Data analysis revealed that when an individualized approach and CBT were combined, the success rate in terms of pain relief was 84% ​​higher than with standard treatment.

Again, this demonstrates that the psychological aspect of chronic back pain is very important.