New urine test may help some men with elevated PSA avoid biopsy
Dupuytren’s contracture of the hand
Why play? Early games build bonds and brain
Moving from couch to 5K
How — and why — to fit more fiber and fermented food into your meals
Tick season is expanding: Protect yourself against Lyme disease
What? Another medical form to fill out?
How do trees and green spaces enhance our health?
A muscle-building obsession in boys: What to know and do
Harvard Health Ad Watch: New drug, old song, clever tagline
Harvard Health Blog
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.
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.
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.
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles.
No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
New urine test may help some men with elevated PSA avoid biopsy
Dupuytren’s contracture of the hand
Why play? Early games build bonds and brain
Moving from couch to 5K
How — and why — to fit more fiber and fermented food into your meals
Tick season is expanding: Protect yourself against Lyme disease
What? Another medical form to fill out?
How do trees and green spaces enhance our health?
A muscle-building obsession in boys: What to know and do
Harvard Health Ad Watch: New drug, old song, clever tagline
Pain
Pain
Pain
Get the latest in health news delivered to your inbox!
© 2024 Harvard Health Publishing® of The President and Fellows of Harvard College
Do not sell my personal information | Privacy Policy and Terms of Use
Thanks for visiting. Don’t miss your FREE gift.
The Best Diets for Cognitive Fitness, is yours absolutely FREE when you sign up to receive Health Alerts from Harvard Medical School
Sign up to get tips for living a healthy lifestyle, with ways to fight inflammation and improve cognitive health, plus the latest advances in preventative medicine, diet and exercise, pain relief, blood pressure and cholesterol management, and more.
Health Alerts from Harvard Medical School
Get helpful tips and guidance for everything from fighting inflammation to finding the best diets for weight loss…from exercises to build a stronger core to advice on treating cataracts. PLUS, the latest news on medical advances and breakthroughs from Harvard Medical School experts.
BONUS! Sign up now and
get a FREE copy of the
Best Diets for Cognitive Fitness
Stay on top of latest health news from Harvard Medical School.
Plus, get a FREE copy of the Best Diets for Cognitive Fitness.
