It is difficult to exaggerate the damage and prevalence of chronic back pain. As the leading cause of disability globally, this disease affects approximately 8% of American adults, causing more than 80 million working days lost and US$12 billion in health care costs each year. The root cause of chronic back pain is sometimes obvious: injury, poor posture, or certain genetic diseases.
But many cases lack clear reasons. A study of American veterans with chronic back pain in 1946 put forward the culprit of these mysterious cases for the first time: anxiety. The research shows that chronic back pain is not necessarily caused by injuries or unhealthy exercises in the physical world, but may be caused by psychological distress. The study pointed out: “When psychiatric treatment relieves anxiety, back pain caused by muscle tension will be improved.”
A paper recently published in a journal pain report Explored the efficacy of a new treatment for chronic back pain, which also defines this condition as being mainly rooted in psychology. Although it is not the first physical and mental therapy to treat back pain, the results suggest that it may be the most effective.
Psychophysiological methods for the treatment of back pain
The study involved 35 participants, all of whom suffered from chronic back pain that was not caused by an obvious injury. Participants were randomly divided into three groups.
A person was instructed to seek guidance from their regular doctor. The other group was assigned to receive mindfulness-based stress reduction (MSBR), which is a meditation-based therapy designed to help people improve their mental management of stress. The third group was assigned to receive a new treatment: Psychophysiological Symptom Relief Therapy (PSRT). (Psychophysiology is a branch of physiology that studies the relationship between mental and physical processes.) Researchers describe their new therapy as:
“…Based on the hypothesis that non-specific back pain is a symptom manifestation of a psychophysiological process, which is essentially driven by stress, negative emotions and other psychological processes. This intervention addresses the potential stressors that cause persistent pain And psychological factors (including potential pressure conflicts and disgusting emotional states), as well as conditioned pain responses and fear avoidance behaviors.”
A long-term study supports this psychosomatic hypothesis, showing that people with chronic back pain also tend to suffer higher levels of psychological distress, including feelings of sadness, anger, and anxiety. It is difficult to determine whether back pain causes psychological distress, and vice versa.
But it is obvious that having back pain and psychological distress at the same time will exacerbate these two problems. A 2019 systematic review stated that people with chronic low back pain and depression are more likely to experience “higher pain intensity, greater disability, and poorer quality of life”, as well as worse treatment outcomes. .
Psychotherapy to relieve chronic back pain
PSRT treatment lasted 12 weeks. In the first four weeks of the program, participants learned the psychophysiological model of pain developed by the late John Sarno, a professor of rehabilitation medicine at New York University School of Medicine. Sarno’s main hypothesis is that chronic stress causes chronic pain. He believes that the cure for chronic pain is to treat underlying psychological problems, such as depressed emotions.
In group meetings, participants read books about chronic pain and discussed with doctors and psychophysical experts. The goal is to clarify the connection between stress and pain and help people break them.
“When participants were encouraged to examine the origin of pain, they noticed that the pattern of pain experience reflected the contribution of psychological and stress-related factors (for example, experiencing severe back pain while driving, but only in heavy traffic. This happens when sitting sometimes, but not when sitting in a chair lift. The pain will be more severe when entering the workplace, but it will be less when walking away),” the researchers pointed out.
“As a result, participants are aware of the connection between pain and mental processes and have a better understanding of the various potential variables that cause chronic back pain.”
In the second phase of treatment, participants spent eight weeks learning and practicing MSBR. All groups filled out the pain questionnaire regularly before the start of the study, during each treatment, and within six months after the end of the specific treatment.
So far, the PSRT group has shown the greatest improvement. After 4 weeks, PSRT participants reported an 83% reduction in pain and disability, compared with a 22% reduction in the MSBR group and an 11% reduction in participants receiving routine care. In terms of pain, the PSRT group improved by 60%, while the MSBR group improved by 8%, and the routine care group improved by 18%.
These differences remain consistent over the long term. After six months, 63% of participants in the PSRT group reported complete painlessness, compared with 25% in the MSBR group and 16% in the routine care group. Nevertheless, the researchers pointed out that a larger randomized trial will increase confidence in the efficacy of the therapy, which has not yet been made available to the public.
The researchers finally emphasized the novelty of their method.
“Mindfulness-based interventions aim to reduce pain through stress reduction and a variety of other unique neural mechanisms, regardless of the cause of the pain,” they wrote. “In contrast, PSRT recognizes and treats pain as a manifestation of psychosomatic or psychophysiological disorders. This subtle but fundamental difference provides patients with a completely different pain location.”